Kathrin Steffen

• Steffen, Kathrin; Bahr, Roald; Clarsen, Benjamin Matthew; Fossan, Bjorn; Fredriksen, Hilde & Gjelsvik, Hilde [Show all 15 contributors for this article] (2024). Comprehensive periodic health evaluations of 454 Norwegian Paralympic and Olympic athletes over 8 years: What did we learn? British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2023-107942.
• Lison, Andreas; Hirschmüller, Anja; Steffen, Kathrin; Ocenasek, Helmut; Pieber, Karin & Stinus, Hartmut [Show all 8 contributors for this article] (2024). Guidelines for the prepartition examination of people with a disability. Sports Orthopaedics and Traumatology. ISSN 0949-328X. doi: 10.1016/j.orthtr.2023.09.006.
• Edouard, P.; Steffen, Kathrin; Peuriere, M.; Gardet, P.; Navarro, L. & Blanco, D. (2024). Infographic: Evaluation of the efficacy of an injury prevention program in athletics in a randomized controlled trial including 840 athletes over 39 weeks. Journal de Traumatologie du Sport. ISSN 0762-915X. 41(1), p. 90–92. doi: 10.1016/j.jts.2023.12.003.
• Clarsen, Benjamin Matthew; Berge, Hilde Moseby; Bendiksen, Fredrik; Fossan, Bjørn; Fredriksen, Hilde & Haugvad, Lars [Show all 11 contributors for this article] (2023). Injury and illness among Norwegian Olympic athletes during preparation for five consecutive Summer and Winter Games. British Journal of Sports Medicine. ISSN 0306-3674. 58(1), p. 18–24. doi: 10.1136/bjsports-2023-107128. Show summary

  Objective: To describe the patterns of health problems among Norwegian Olympic candidates during their preparations for five consecutive Olympic Games (London 2012, Sochi 2014, Rio de Janeiro 2016, PyeongChang 2018 and Tokyo 2020). Methods: This was a descriptive epidemiological study using the Oslo Sports Trauma Research Center Questionnaire on Health Problems to collect data on all self-reported health problems from Norwegian Olympic candidate athletes for 12–18 months prior to each Olympic Games. Team physicians and physiotherapists followed up the athlete reports, providing clinical care and classifying reported problems according to the International Olympic Committee 2020 consensus statement on methods for recording and reporting of epidemiological data on injury and illness in sport. Results: Between 2011 and 2020, 533 athletes were included in the Norwegian Olympic team monitoring programme, with a 78% response to the weekly questionnaire. During this time, athletes reported 2922 health problems, including 1409 illnesses (48%), 886 overuse injuries (repetitive mechanism, 30%) and 627 acute injuries (traumatic mechanism, 21%). Diagnostic codes were recorded for 2829 (97%) of health problems. Athletes reported, on average, 5.9 new health problems per year (95% CI: 5.6 to 6.1), including 1.3 acute injuries (CI: 1.2 to 1.4), 1.7 overuse injuries (CI: 1.6 to 1.9) and 2.9 illnesses (CI: 2.7 to 3.0). Each year, female and male athletes lost an average of 40 and 26 days of training and competition due to health problems, respectively. The diagnoses with the highest health burden were anterior cruciate ligament rupture, respiratory infection, lumbar pain and patellar tendinopathy. Conclusion: The injury burden was particularly high among female athletes and in team sports, whereas endurance sports had the greatest burden of illness. Our data provide a compelling argument for prioritising medical care and investing in prevention programmes not just during the Olympic Games, but also the preparation period.

• Drury, Anne; Engebretsen, Lars; Steffen, Kathrin; Soligard, Torbjørn; Liu, Ran & Forster, Bruce B. (2023). Utilization of Imaging for Severe Injuries at the Beijing 2022 Winter Olympic Games. Canadian Association of Radiologists Journal. ISSN 0846-5371. doi: 10.1177/08465371231212110. Full text in Research Archive
• Koivisto-Mørk, Anu; Steffen, Kathrin; Finnes, Trine Elisabeth; Pretorius, Mikkel & Berge, Hilde Moseby (2023). High prevalence of low bone mineral density but normal trabecular bone score in Norwegian elite Para athletes. Frontiers in Sports and Active Living. ISSN 2624-9367. 5. doi: 10.3389/fspor.2023.1246828. Full text in Research Archive Show summary

  Background: Low bone mineral density (BMD) increases the risk of bone stress injuries (BSI) and is one of several clinical concerns in Para athlete sports medicine. However, whether bone microarchitecture is altered in Para athletes is not known. Objective: We aimed to investigate BMD, bone microarchitecture and incidence of bone stress injuries in Norwegian elite Para athletes. Design: In this cross-sectional study in Para athletes, Dual energy x-ray absorptiometry (iDXA, Lunar, GE Health Care) derived areal BMD, trabecular bone score (TBS), a surrogate marker for bone microarchitecture, and body composition (body weight (BW), lean body mass (LBM), fat mass (FM), fat percentage) were investigated and compared between ambulant and non-ambulant athletes. Also, the association between BMD, TBS and body composition variables was investigated. Incidence of BSI was assessed with a questionnaire and confirmed by a sports physician in a clinical interview. BMD Z-score <−1 was defined as low and ≤−2 as osteoporotic. TBS ≥ 1.31 was normal, 1.23–1.31 intermediate and <1.23 low. Results: Among 38 athletes (26 ± 6 yrs, 14 females), BMD Z-score was low in 19 athletes, and osteoporotic in 11 athletes' lumbar spine (LS) or femoral neck (FN). BMD was lower in non-ambulant vs. ambulant athletes both in LS (1.13 ± 0.19 vs. 1.25 ± 0.14 g/cm2, p = 0.030) and FN (0.90 ± 0.15 vs. 1.07 ± 0.16 g/cm2, p = 0.003). TBS was normal for all athletes. BMD Z-score in LS was positively associated with TBS (r = 0.408, p = 0.013), body weight (r = 0.326, p = 0.046) and lean body mass (r = 0.414, p = 0.010), but not with fat mass or fat percentage. None of the athletes reported any BSI. Conclusions: Half of the Norwegian elite Para athletes had low BMD, and 29% had BMD Z-score <−2 suggesting osteoporosis. Non-ambulant athletes were more prone to low BMD than ambulant athletes. However, despite high prevalence of low BMD, TBS was normal in all athletes, and BSI was absent in this young population.

• Soligard, Torbjørn; Palmer, Debbie; Steffen, Kathrin; Lopes, Alexandre Dias; Grek, Natalia & He, Xuan [Show all 12 contributors for this article] (2023). Olympic Games during nationwide lockdown: Sports injuries and illnesses, including COVID-19, at the Beijing 2022 Winter Olympics. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2023-107412. Full text in Research Archive Show summary

  Objective: The objective of this study is to describe the incidence of injuries and illnesses sustained during the Beijing Winter Olympic Games from 4 February 2022 to 20 February 2022. Methods: We recorded the daily number of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the Beijing 2022 medical staff. Results: In total, 2848 athletes (1276 women, 45%; 1572 men, 55%) from 91 NOCs were followed prospectively for the occurrence of injury and illness. NOC and Beijing 2022 medical staff reported 289 injuries and 109 illnesses, equalling 10.1 injuries and 3.8 illnesses per 100 athletes over the 17-day period. The injury incidence was highest in ski halfpipe (30%), ski big air (28%), snowboard slopestyle (23%) and ski slopestyle (22%), and lowest (1%–2%) in curling, alpine mixed team parallel slalom, Nordic combined and alpine super-G. The illness incidence was highest in ski aerials (10%), skeleton (8%), cross-country skiing (8%) and Nordic combined (7%). In the study period, COVID-19 affected 32 athletes, accounting for 29% of all illnesses affecting 1.1% of all athletes. Conclusion: Overall, 10% of the athletes incurred an injury and 4% an illness during the Beijing Winter Olympic Games. The incidence of illnesses overall, which was the lowest yet recorded in the Winter Olympic Games, and COVID-19 was mitigated through comprehensive countermeasures.

• Moe, Morten Carsten; Özmert, Emin; Baudouin, Christophe; Binadra, Abhinav; Crafoord, Sven & Jo, Young [Show all 16 contributors for this article] (2023). International Olympic Committee (IOC) consensus paper on sports-related ophthalmology issues in elite sports. BMJ Open sport & exercise medicine. ISSN 2055-7647. 9(3). doi: 10.1136/bmjsem-2023-001644. Full text in Research Archive
• Edouard, Pascal; Blanco, D.; Steffen, Kathrin; Nielsen, R.O.; Verhagen, E. & Ruffault, A. (2023). Which Athletes Fail Faster to Send Weekly Questionnaires or to Comply with an Injury Risk Reduction Program? Deutsche Zeitschrift für Sportmedizin. ISSN 0344-5925. 74(1), p. 24–28. doi: 10.5960/dzsm.2022.554. Full text in Research Archive Show summary

  Problem: Low response rate to weekly self-reported questionnaires used to obtain athlete health-related and risk exposure data and low compliance with intervention have been reported. We thus aimed to investigate if time to 1) non-response to a weekly questionnaire and 2) non-compliance with an intervention is different among French athletics athletes with different characteristics. Methods: We performed a secondary analysis of data from the PREVATHLE randomized controlled trial including 840 female and male competitive athletics athletes followed over 39-weeks. Using univariate Cox proportional hazards regression models, we analyzed the association between athletes’ baseline characteristics and the following outcomes: time to failing to (1) respond to a weekly questionnaire and (2) complete a prescribed intervention. Results: Most athletes failed to complete all questionnaires over the 39 weeks (n=672, 80%), athletes in the intervention group, female athletes, younger athletes, athletes performing explosive disciplines, and athletes with higher non-specific sport training failed sooner. Nearly all athletes in the intervention group failed to comply with the intervention (n=443; 98.7%), and the rates were similar amongst athletes with different characteristics. Conclusions: This study shows that novel ways have to be found in order to improve both 1) athletes’ self-reported responses to weekly questionnaires on health-related and risk exposure data and 2) athletes’ compliance with an injury risk reduction program. Education and/or digital solutions might be potential opportunities.

• Drole, Kristina; Paravlic, Armin; Steffen, Kathrin & Doupona, Mojca (2023). Effects of physical, psychosocial and dual-career loads on injuries and illnesses among elite handball players: protocol of prospective cohort study. BMJ Open. ISSN 2044-6055. 13(3). doi: 10.1136/bmjopen-2022-069104.
• Soligard, Torbjørn; Palmer, Debbie; Steffen, Kathrin; Lopes, Alexandre Dias; Grek, Natalia & Onishi, Kentaro [Show all 11 contributors for this article] (2022). New sports, COVID-19 and the heat: sports injuries and illnesses in the Tokyo 2020 Summer Olympics. British Journal of Sports Medicine. ISSN 0306-3674. 57(1). doi: 10.1136/bjsports-2022-106155. Show summary

  Objective: To describe the incidence of injuries and illnesses sustained during the Tokyo Summer Olympic Games from 23 July to 8 August 2021. Methods: We recorded the daily number of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the Tokyo 2020 medical staff. Results: In total, 11 315 athletes (5423 women, 48%; 5892 men, 52%) from 206 NOCs were followed up prospectively for the occurrence of injury and illness. NOC and Tokyo 2020 medical staff reported 1035 injuries and 438 illnesses, equalling 9.1 injuries and 3.9 illnesses per 100 athletes over the 17-day period. Altogether, 9% of the athletes incurred at least one injury and 4% at least one illness. The incidence of injury was highest in boxing (27%), BMX racing (27%), BMX freestyle (22%), skateboarding (21%), karate (19%) and handball (18%), of which both BMX freestyle and skateboarding were new events, and lowest in diving, road cycling, rowing, marathon swimming and shooting (1–2%). Marathon and artistic swimming presented the highest illness incidences (both 8%), followed by skateboarding and karate (both 7%). In the study period, COVID-19 affected 18 athletes, accounting for 4% of all illnesses and 0.16% of all athletes. Exertional heat illness affected 78 athletes (18% of all illnesses, 0.7% of all athletes), the majority (88%) resulting in no time lost from sport. Conclusion: Overall, 9% of the athletes incurred an injury and 4% an illness during the Games. Comprehensive countermeasures helped mitigate both COVID-19 and exertional heat illnesses.

• Palmer, Debbie; Cooper, Dale; Whittaker, Jackie L; Emery, Carolyn; Batt, Mark E & Engebretsen, Lars [Show all 11 contributors for this article] (2022). Prevalence of and factors associated with osteoarthritis and pain in retired Olympians, with comparison to the general population: part 1 - the lower limb. British Journal of Sports Medicine. ISSN 0306-3674. 56(19), p. 1123–1131. doi: 10.1136/bjsports-2021-104762. Full text in Research Archive Show summary

  Objectives: This study aims (1) to determine the prevalence of lower limb osteoarthritis (OA) and pain in retired Olympians; (2) to identify factors associated with their occurrence and (3) to compare with a sample of the general population. Methods: 3357 retired Olympians (median 44.7 years) and 1735 general population controls (40.5 years) completed a cross-sectional survey. The survey captured demographics, general health, self-reported physician-diagnosed OA, current joint/region pain and injury history (lasting >1 month). Adjusted OR (aOR) compared retired Olympians with the general population. Results: The prevalence of (any joint) OA in retired Olympians was 23.2% with the knee most affected (7.4%). Injury was associated with increased odds (aOR, 95% CI) of OA and pain in retired Olympians at the knee (OA=9.40, 6.90 to 12.79; pain=7.32, 5.77 to 9.28), hip (OA=14.30, 8.25 to 24.79; pain=9.76, 6.39 to 14.93) and ankle (OA=9.90, 5.05 to 19.41; pain=5.99, 3.84 to 9.34). Increasing age and obesity were also associated with knee OA and pain. While the odds of OA did not differ between Olympians and the general population, Olympians with prior knee and prior hip injury were more likely than controls with prior injury to experience knee (1.51, 1.03 to 2.21 (Olympians 22.0% vs controls 14.5%)) and hip OA (4.03, 1.10 to 14.85 (Olympians 19.1% vs Controls 11.5%)), respectively. Conclusions: One in four retired Olympians reported physician-diagnosed OA, with injury associated with knee, hip and ankle OA and pain. Although overall OA odds did not differ, after adjustment for recognised risk factors Olympians were more likely to have knee and hip OA after injury than the general population, suggesting injury is an occupational risk factor for retired Olympians.

• Palmer, Debbie; Cooper, Dale; Whittaker, Jackie L; Emery, Carolyn; Batt, Mark E & Engebretsen, Lars [Show all 11 contributors for this article] (2022). Prevalence of and factors associated with osteoarthritis and pain in retired Olympians compared with the general population: part 2 - the spine and upper limb. British Journal of Sports Medicine. ISSN 0306-3674. 56(19), p. 1132–1140. doi: 10.1136/bjsports-2021-104978. Full text in Research Archive Show summary

  Objectives: (1) To determine the prevalence of spine and upper limb osteoarthritis (OA) and pain in retired Olympians; (2) identify risk factors associated with their occurrence and (3) compare with a sample of the general population. Methods: 3357 retired Olympians (44.7 years) and 1735 general population controls (40.5 years) completed a cross-sectional survey. The survey captured demographics, general health, self-reported physician-diagnosed OA, current joint/region pain and significant injury (lasting ≥1 month). Adjusted ORs (aORs) compared retired Olympians and the general population. Results: Overall, 40% of retired Olympians reported experiencing current joint pain. The prevalence of lumbar spine pain was 19.3% and shoulder pain 7.4%, with lumbar spine and shoulder OA 5.7% and 2.4%, respectively. Injury was associated with increased odds (aOR, 95% CI) of OA and pain at the lumbar spine (OA=5.59, 4.01 to 7.78; pain=4.90, 3.97 to 6.05), cervical spine (OA=17.83, 1.02 to 31.14; pain=9.41, 6.32 to 14.01) and shoulder (OA=4.91, 3.03 to 7.96; pain=6.04, 4.55 to 8.03) in retired Olympians. While the odds of OA did not differ between Olympians and the general population, the odds of lumbar spine pain (1.44, 1.20 to 1.73), the odds of shoulder OA after prior shoulder injury (2.64, 1.01 to 6.90) and the odds of cervical spine OA in female Olympians (2.02, 1.06 to 3.87) were all higher for Olympians compared with controls. Conclusions: One in five retired Olympians reported experiencing current lumbar spine pain. Injury was associated with lumbar spine, cervical spine and shoulder OA and pain for Olympians. Although overall OA odds did not differ, after adjustment for recognised risk factors, Olympians were more likely to have lumbar spine pain and shoulder OA after shoulder injury, than the general population.

• Hietamo, Jussi; Rantala, Anni; Parkkari, Jari; Leppänen, Mari; Rossi, Marko & Heinonen, Ari [Show all 10 contributors for this article] (2022). Injury History and Perceived Knee Function as Risk Factors for Knee Injury in Youth Team-Sports Athletes. Sports Health: A Multidisciplinary Approach (SPH). ISSN 1941-7381. doi: 10.1177/19417381211065443. Full text in Research Archive Show summary

  Background: The identification of risk factors for sports injuries is essential before injury prevention strategies can be planned. Hypothesis: Previous acute knee injury and lower perceived knee function measured by Knee injury and Osteoarthritis Outcome Score (KOOS) will increase the risk of acute knee injury in youth team-sports athletes. Study Design: Prospective cohort study. Level of Evidence: Level 3. Methods: At baseline, youth (≤21 years old) male and female basketball and floorball athletes completed a questionnaire on previous acute knee injuries and perceived knee function (KOOS). A total of 211 male and 183 female athletes were followed for an acute knee injury up to 3 years. Unadjusted and adjusted Cox regression models were used in risk factor analyses. Results: In male athletes, previous acute knee injury and lower KOOS Pain, Activities of Daily Living, Sport and Recreation, and knee-related Quality of Life subscale scores increased the risk of acute knee injury in the unadjusted analyses. Adjusted analyses for male injuries were not performed because of low number of acute knee injuries (n = 18). In female athletes, previous acute knee injury increased the risk of acute knee injury when adjusted for athletes’ age and body mass index (hazard ratio, 2.6 [95% CI, 1.3-5.2]). In female athletes, none of the KOOS subscale scores were associated with the increased risk of acute knee injury in the adjusted analyses. Conclusion: Previous acute knee injury was associated with the risk of new acute knee injury in youth male and female athletes. In youth male athletes, additionally, lower perceived knee function in 4 out of 5 KOOS subscale scores were associated with the increased risk of new acute knee injury.

• Hilska, Matias; Leppänen, Mari; Vasankari, Tommi; Aaltonen, Sari; Raitanen, Jani & Räisänen, Anu M. [Show all 11 contributors for this article] (2021). Adherence to an Injury Prevention Warm-Up Program in Children’s Soccer — A Secondary Analysis of a Randomized Controlled Trial. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(24), p. 1–12. doi: 10.3390/ijerph182413134. Full text in Research Archive Show summary

  This study examined the impact of high adherence to a neuromuscular training (NMT) warm-up on the risk of lower extremity (LE) injuries in children’s soccer. Twenty U11–U14 youth clubs (n = 92 teams, 1409 players) were randomized into intervention (n = 44 teams) and control (n = 48 teams) groups. The intervention group was advised to perform an NMT warm-up 2 to 3 times a week for 20 weeks. Team adherence, injuries, and exposure were registered throughout the follow-up. Primary outcomes were the incidence of soccer-related acute LE injuries and the prevalence of overuse LE injuries. Intervention teams conducted mean 1.7 (SD 1.0) NMT warm-ups weekly through follow-up. The seasonal trend for adherence declined significantly by −1.9% (95% CI −0.8% to −3.1%) a week. There was no difference in the incidence of acute injuries nor the prevalence of overuse LE injuries in high team adherence group (n = 17 teams) compared to controls. However, the risk for acute noncontact LE injuries was 31% lower in the high team adherence group compared to controls (IRR 0.69, 95% CI 0.49 to 0.97). In an efficacy analysis (n = 7 teams), there was a significant reduction of 47% in the rate of noncontact LE injuries (IRR 0.53, 95% CI 0.29 to 0.97). In conclusion, teams conducted NMT warm-up sessions regularly, but with a declining trend. A greater protective effect was seen in teams with the highest adherence to the NMT warm-up.

• Edouard, Pascal; Steffen, Kathrin; Peuriere, Marie; Gardet, Pierre; Navarro, Laurent & Blanco, David (2021). Effect of an unsupervised exercises-based athletics injury prevention programme on injury complaints leading to participation restriction in athletics: A cluster-randomised controlled trial. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(21), p. 1–15. doi: 10.3390/ijerph182111334. Full text in Research Archive Show summary

  Objective: To test the efficacy of the Athletics Injury Prevention Programme (AIPP) to reduce the percentage of athletes presenting at least one injury complaint leading to participation restriction (ICPR) over an athletics season. Methods: During the 2017–2018 athletics season, we included in this cluster randomised controlled trial (ClinicalTrials.gov Identifier: NCT03307434) 840 athletes randomly assigned (randomisation unit: athletic clubs) to a control group (regular training) or to an intervention group (regular training plus the AIPP 2/week). Using a weekly online questionnaire, athletes reported the ICPR, training and competition exposures, and, for the intervention group, the compliance with the AIPP. The primary outcome was the percentage of athletes presenting at least one ICPR over the study follow-up. Results: A total of 449 and 391 athletes were included in the intervention and control groups, respectively. From them, 68 (15.1%) and 100 (25.6%) athletes, respectively, provided 100% of the requested information during the follow-up (39 weeks). A total of 6 (8.8%) performed the AIPP 2/week or more. The proportion of athletes who had at least one ICPR over the follow-up period was similar in the intervention (64.7%) and control groups (65.0%), with adjusted odds ratios: 0.81 (95% CI 0.36 to 1.85). There were no between-group differences when comparing separately the subgroups corresponding with the different compliance levels. Conclusion: This cluster randomised controlled trial reported no efficacy of the AIPP. However, the overall response proportion and the compliance with the AIPP in the intervention group were low. In individual sports especially, efforts should be first made to improve the implementation and adoption of interventions.

• Derman, Wayne; Badenhorst, Marelise; Blauwet, Cheri; Emery, Carolyn A.; Fagher, Kristina & Lee, Young-Hee [Show all 15 contributors for this article] (2021). Para sport translation of the IOC consensus on recording and reporting of data for injury and illness in sport statement [Consensus statement]. British Journal of Sports Medicine. ISSN 0306-3674. 55(19), p. 1068–1076. doi: 10.1136/bjsports-2020-103464. Show summary

  In 2020, the IOC proposed a universal methodology for the recording and reporting of data for injury and illness in sport. Para sport is played by individuals with impairment, and they have a unique set of considerations not captured by these recommendations. Therefore, the aim of this addendum to IOC consensus statement was to guide the Para sport researcher through the complexities and nuances that should be taken into consideration when collecting, registering, reporting and interpreting data regarding Para athlete health. To develop this translation, experts in the field of Para sports medicine and epidemiology conducted a formal consensus development process, which began in March 2020 with the formation of a consensus group that worked over eight phases, incorporating three virtual consensus meetings to finalise the translation. This translation is consistent with the IOC consensus statement, yet provides more detailed Para athlete specific definitions and recommendations on study population, specifically, diagnostic and eligible impairment categorisation and recording of adaptive equipment, and defining and classifying health problems in the context of Para sport. Additionally, recommendations and Para athlete specific examples are described with regards to injury mechanism, mode of onset, injury and illness classification, duration, capturing and reporting exposure and risk. Finally, methods and considerations are provided to cater to the varied needs of athletes with impairment with respect to data collection tools. This harmonisation will allow the science to develop and facilitate a more accurate understanding of injury and illness patterns for tailoring evidence-informed prevention programmes and enabling better planning of medical services for Para sport events.

• Steffen, Kathrin; Clarsen, Benjamin Matthew; Gjelsvik, Hilde; Haugvad, Lars; Koivisto-Mørk, Anu & Bahr, Roald [Show all 7 contributors for this article] (2021). Illness and injury among Norwegian Para athletes over five consecutive Paralympic Summer and Winter Games cycles: prevailing high illness burden on the road from 2012 to 2020. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2021-104489. Full text in Research Archive Show summary

  Objective: To describe the illness and injury pattern of Norwegian Para athletes over five consecutive Paralympic Summer and Winter Games cycles and to identify which health problems should be targeted in risk management plans with respect to impairment types. Methods: We monitored athletes from 12 to 18 months prior to each Game using a weekly online questionnaire (Oslo Sports Trauma Research Center-H2 (OSTRC-H2)). We asked them to report all health problems they had experienced in the preceding 7 days, irrespective of their consequences on their sports participation or performance and whether they had sought medical attention. Results: Between 2011 and 2020, 94 candidate athletes were included in this monitoring programme and prepared to represent Norway; of these, 66 (71%) were finally selected for multiple Paralympic Games. The overall response rate to the weekly questionnaires was 87%. At any given time during the five observation cycles, 37% of the athletes (95% CI 36% to 38%) reported having at least one health problem. Athletes with neurological impairments (n=51) lost 10 days per year due to respiratory problems (95% CI 9 to 11) compared with 9 days (8-10) among those with musculoskeletal impairments (n=37). Gastrointestinal problems caused a time loss of on average 4 days per year in athletes with neurological impairments versus 1 day in athletes with musculoskeletal impairments (mean difference 2.7 days, 2.1–3.3). Musculoskeletal injuries generated a high burden for both athlete groups, in particular, to the elbow, shoulder and lumbosacral regions. Conclusion: At any given time, nearly two out of five elite Norwegian Para athletes reported at least one health problem. Respiratory tract and other infections; gastrointestinal problems, injuries to the shoulder, elbow and lumbosacral regions represented the greatest health burden. Our findings can help guide the allocation of clinical resources, which should include a broad network of medical specialists, together with dieticians and physiotherapists, to meet the health challenges in Para athletes.

• Hilska, Matias; Leppänen, Mari; Vasankari, Tommi; Aaltonen, Sari; Kannus, Pekka & Parkkari, Jari [Show all 11 contributors for this article] (2021). Neuromuscular Training Warm-up Prevents Acute Noncontact Lower Extremity Injuries in Children’s Soccer: A Cluster Randomized Controlled Trial. Orthopaedic Journal of Sports Medicine (OJSM). ISSN 2325-9671. 9(4). doi: 10.1177/23259671211005769. Full text in Research Archive Show summary

  Background: Prevention of sports injuries is essential in youth, as injuries are associated with less future physical activity and thus greater all-cause morbidity. Purpose: To investigate whether a neuromuscular training warm-up operated by team coaches is effective in preventing acute lower extremity (LE) injuries in competitive U11-U14 soccer players. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Twenty top-level U11 to U14 soccer clubs in Finland were randomized into intervention and control groups and assessed for 20 weeks. Participants included 1403 players (280 female, 1123 male; age range, 9-14 years): 673 players (44 teams) in the intervention group and 730 players (48 teams) in the control group. The intervention group team coaches were introduced to a neuromuscular training warm-up to replace the standard warm-up 2 to 3 times per week. The control teams were asked to perform their standard warm-up. Injury data collection was done via weekly text messages. The primary outcome measure was a soccer-related acute LE injury, and the secondary outcome measure was an acute noncontact LE injury. Results: A total of 656 acute LE injuries occurred: 310 in the intervention group and 346 in the control group. The overall acute LE injury incidence was 4.4 per 1000 hours of exposure in the intervention group and 5.5 per 1000 hours of exposure in the control group, with no significant difference between groups (incidence rate ratio [IRR], 0.82 [95% CI, 0.64-1.04]). There were 302 acute noncontact LE injuries: 129 in the intervention group (incidence, 1.8 per 1000 hours) and 173 in the control group (2.7 per 1000 hours). A significant reduction in acute noncontact LE injuries of 32% (IRR, 0.68 [95% CI, 0.51-0.93]) was observed in the intervention group compared with the control group. Furthermore, significant reductions in injury incidence in favor of the intervention group were seen in the subanalyses of acute noncontact LE injuries, leading to ≤7 days of time loss and fewer ankle and joint/ligament injuries. Conclusion: A neuromuscular training warm-up operated by team coaches was found to be effective in preventing acute noncontact LE injuries in children’s soccer, but this was not seen in all acute LE injuries.

• Clarsen, Benjamin Matthew; Steffen, Kathrin; Berge, Hilde Moseby; Bendiksen, Fredrik; Fossan, Bjørn & Fredriksen, Hilde [Show all 13 contributors for this article] (2021). Methods, challenges and benefits of a health monitoring programme for Norwegian Olympic and Paralympic athletes: the road from London 2012 to Tokyo 2020. British Journal of Sports Medicine. ISSN 0306-3674. 55, p. 1342–1349. doi: 10.1136/bjsports-2020-103717. Full text in Research Archive
• Hietamo, Jussi; Pasanen, Kati; Leppänen, Mari; Steffen, Kathrin; Kannus, Pekka & Heinonen, Ari [Show all 8 contributors for this article] (2021). Association between lower extremity muscle strength and acute ankle injury in youth team-sports athletes. Physical Therapy in Sport. ISSN 1466-853X. 48, p. 188–195. doi: 10.1016/j.ptsp.2021.01.007. Full text in Research Archive Show summary

  Objectives: To investigate lower extremity muscle strength as risk factor for an acute ankle injury in youth athletes. Design: Cohort study. Setting: Basketball and floorball clubs. Participants: 188 youth (≤21) male and 174 female athletes. Main outcome measures: 1RM leg press, maximal concentric isokinetic quadriceps and hamstrings as well as maximal isometric hip abductor strength were measured and athletes were followed for an acute ankle injury up to three years. Cox regression models were used in statistical analyses. Results: In males, greater 1RM leg press and maximal quadriceps strength increased the risk of any type of acute ankle injury (Hazard ratio [HR] for 1 SD increase, 1.63 [95% CI, 1.12–2.39] and 1.43 [95% CI, 1.01–2.01], respectively). In females, greater 1RM leg press and difference between legs in hip abduction strength increased the risk of acute non-contact ankle injury (HR for 1 SD increase, 1.44 [95% CI, 1.03–2.02] and 1.44 [95% CI, 1.03–2.00], respectively). However, ROC curve analyses showed AUC:s of 0.57–0.64 indicating “fail” to “poor” combined sensitivity and specifity of these tests. Conclusion: Greater strength in both sexes along with asymmetry in hip abductor strength in females increased the risk of acute ankle injury.

• Palmer, Debbie; Cooper, Dale J.; Emery, Carolyn; Batt, Mark E.; Engebretsen, Lars & Scammell, Brigitte E. [Show all 12 contributors for this article] (2020). Self-reported sports injuries and later-life health status in 3357 retired Olympians from 131 countries: a cross-sectional survey among those competing in the games between London 1948 and PyeongChang 2018. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2019-101772. Full text in Research Archive Show summary

  Objective Describe the self-reported prevalence and nature of Olympic-career injury and general health and current residual symptoms in a self-selected sample of retired Olympians. Methods 3357 retired Olympians from 131 countries completed a cross-sectional online survey, distributed by direct email through World Olympians Association and National Olympian Associations databases. The survey captured Olympic sport exposure, significant training and competition injury history (lasting >1 month), general health (eg, depression) during the athlete’s career, and current musculoskeletal pain and functional limitations. Results 55% were men (44% women, 1% unknown), representing 57 sports (42 Summer, 15 Winter), aged 44.7 years (range 16–97). A total of 3746 injuries were self-reported by 2116 Olympians. In this study population, 63.0% (women 68.1%, men 59.2%) reported at least one significant injury during their Olympic career. Injury prevalence was highest in handball (82.2%) and lowest in shooting (40.0%) for Summer Olympians; and highest in alpine skiing (82.4%) and lowest in biathlon (40.0%) for Winter Olympians. The knee was the most frequently injured anatomical region (20.6%, 120 median days severity), followed by the lumbar spine (13.1%, 100 days) and shoulder/clavicle (12.9%, 92 days). 6.6% of Olympians said they had experienced depression during their career. One-third of retired Olympians reported current pain (32.4%) and functional limitations (35.9%). Conclusions Almost two-thirds of Olympians who completed the survey reported at least one Olympic-career significant injury. The knee, lumbar spine and shoulder/clavicle were the most commonly injured anatomical locations. One-third of this sample of Olympians attributed current pain and functional limitations to Olympic-career injury.

• Hirschmüller, Anja; Fassbender, Katharina; Kubosch, Johanna; Leonhart, Reiner & Steffen, Kathrin (2020). Injury and illness surveillance in elite Paralympians - urgent need for suitable illness prevention strategies in para athletes. American Journal of Physical Medicine & Rehabilitation. ISSN 0894-9115. doi: 10.1097/PHM.0000000000001501. Show summary

  Background: Longitudinal monitoring data of para athletes is sparse. Objective: To describe the weekly prevalence and incidence of injuries and illnesses among German athletes preparing for the 2016 Rio de Janeiro Paralympic Games. Methods: Athletes were invited to weekly report on medical problems, their severity/burden and training load, using the OSTRC Questionnaire on Health Problems (OSTRC-H). In case of any health problem, athletes were contacted and medical support offered. Data were analyzed with regard to impairment type. The acceptance of the monitoring program was evaluated. Results: 58 athletes were followed for 29 weeks, 10.927 athlete-days. At any given time, 28% (95% CI 26-30%) of athletes reported health problems, and 12% (11-14%) substantial health problems. The prevalence of health and illness problems diminished over time by 20.9±4.1% and 16.1±2.9%, P<.001, respectively, based on the means of the first and final five weeks. Paraplegic athletes reported a significantly higher prevalence of all health problems (33%, 29-37%) than non-paraplegic athletes (26%, 23-29%) (P=0.007). Illnesses were in general more severe and resulted in more time loss days. Athletes reported a high satisfaction with the program. Conclusions: At any given time, 28% of German Paralympic athletes reported health problems, and 12% suffered from substantial health problems. For a health team, illnesses seem to be more important to handle than injuries. The OSTRC-H is a suitable method for injury and illness surveillance in para athletes.

• Hietamo, Jussi; Parkkari, Jari; Leppänen, Mari; Steffen, Kathrin; Kannus, Pekka & Vasankari, Tommi [Show all 9 contributors for this article] (2020). Association between lower extremity muscular strength and acute knee injuries in young team-sport athletes. Translational Sports Medicine (TSM). ISSN 2573-8488. 3(6), p. 626–637. doi: 10.1002/tsm2.172. Full text in Research Archive Show summary

  The purpose of this study was to investigate LE muscular strength variables as potential risk factors for all and non-contact acute knee and ACL injuries in young athletes. A total of 188 young (≤21) male and 174 female basketball and floorball players participated in LE muscular strength tests and were followed up to 3 years. The strength test battery consisted of 1RM leg press, maximal concentric isokinetic (60°/s) quadriceps and hamstrings, and maximal isometric hip abductor strength. The outcomes were a new acute knee or ACL injury and a new acute non-contact knee or ACL injury. A total of 51 (17 in males and 34 in females) new acute knee injuries registered and 17 (one in males and 16 in females) of these were ACL injuries. In the adjusted Cox regression models, only lower maximal hip abduction strength (kg/kg) was significantly associated with an increased risk of all knee injuries in males (HR 1.80 [95% CI, 1.03-3.16] for 1 SD decrease in hip abduction). However, ROC curve analysis showed an area under the curve 0.66 revealing that maximal hip abduction strength test cannot be used as a screening tool for an acute knee injury in young male athletes.

• Edouard, Pascal; Cugy, Emmanuelle; Dolin, Romain; Morel, Nicolas; Serra, Jean-Michel & Depiesse, Frédéric [Show all 8 contributors for this article] (2020). The Athletics Injury Prevention Programme Can Help to Reduce the Occurrence at Short Term of Participation Restriction Injury Complaints in Athletics: A Prospective Cohort Study. Sports. ISSN 2075-4663. 8(6). doi: 10.3390/sports8060084. Full text in Research Archive Show summary

  We aimed to determine whether an Athletics Injury Prevention Programme (AIPP), targeting the most common athletics injuries, can reduce the occurrence of injury complaints that lead to restrictions in athletics participation (participation restriction injury complaints) in the short (12 weeks) and long (40 weeks) terms. For our 40-week prospective cohort study (level of evidence 2), we invited inter-regional and national-level athletes to regularly perform the AIPP, which included 8 exercises addressing core stability, hamstring, leg and pelvic muscles strengthening and stretching, and balance exercises. A Cox regression was used to analyse the influence of AIPP on the occurrence of participation restriction injury complaint, adjusted to sex, age, height, body mass, discipline, and history of injury complaints during the preceding season, individual response rate, mean weekly training time, mean weekly number of competition, presented by hazard ratio (HR) with 95% confidence interval (95% CI). At 12 weeks (n = 62 athletes), the AIPP was significantly associated with a lower risk of participation restriction injury complaint HR = 0.36 (95% CI: 0.15 to 0.86), p = 0.02 and HR = 0.29 (95% CI: 0.12 to 0.73), p = 0.009, with cumulative weeks and cumulative training time as time scale, respectively, while at 40 weeks (n = 53 athletes) there was no significant association. An 8-exercise injury prevention programme can effectively help to reduce occurrence of injury complaints that would restrict an athlete’s participation in athletics in the short term.

• Grant, Marie-Elaine; Steffen, Kathrin & Palmer, Debbie (2020). The usage of multidisciplinary physical therapies at the Rio de Janeiro 2016 Olympic Summer Games: an observational study. Brazilian Journal of Physical Therapy. ISSN 1413-3555. doi: 10.1016/j.bjpt.2020.06.001. Show summary

  Background: This observational research study analyses the uptake of physical therapies treatments in the Polyclinic during the Rio 2016 Olympic Games. Objective: To describe the usage of physical therapies services - physical therapy, osteopath,chiropractic, and sports massage - by athletes and non-athletes and across different sports. Methods: The multidisciplinary team of physical therapies recorded treatment modalities, information on provider discipline and reason for attendance, in an Electronic Medical Recordsystem throughout the 32 days of operation of the Olympic Polyclinic. Cold-therapy total immersion ice baths (TIIB) were provided as part of the services, but were reported and analysed separately. Results: There were 4993 encounters (4038 athletes, 955 non-athlete encounters). 1395 athletes (12.4% of all athletes) and 393 non-athletes sought treatment. For all four provider disciplines, in addition to TIIB, the primary reason for athlete attendance was for recovery (52% of all encounters), followed by injury treatment (30%), and maintenance (16%). Athletes reported ‘‘injury’’ as the main reason for physical therapy (92% of all encounters, 2.8 encounters per athlete), chiropractic (94%, 1.9) and osteopathy (91%, 1.8) visits. Almost all TIIB visits were used for recovery (98% of all TIIB encounters; 2.1 encounters per athlete). Athletes from handball (37% of all handball athletes), followed by judo (22%), and athletics (21%), presented the largest user groups.

• Steffen, Kathrin; Soligard, Torbjørn; Mountjoy, Margo; Dallo, Ignacio; Gessara, Alan Maximiliano & Giuria, Hernan [Show all 12 contributors for this article] (2020). How do the new Olympic sports compare with the traditional Olympic sports? Injury and illness at the 2018 Youth Olympic Summer Games in Buenos Aires, Argentina. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2019-101040. Full text in Research Archive Show summary

  Objective: To describe injuries and illnesses across traditional and new sports among the participating athletes of the Buenos Aires 2018 Youth Olympic Summer Games (BA YOG) (6–18 October 2018). Methods: We recorded the daily number of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues manned by the BA YOG 2018 medical staff. Results: In total, 3.984 athletes from 206 NOCs were observed. NOCs and BA YOG 2018 medical staff reported 619 injuries and 334 illnesses, equalling 15.5 injuries and 8.4 illnesses per 100 athletes over the 13-day period. The eight new sports on the Youth Olympic programme (futsal, beach handball, karate, roller speed skating, kitesurfing, BMX freestyle, climbing and break dancing) fell in between the other sports with respect to injury and illness risk. Injury incidence was highest in rugby (43% of all rugby players), followed by boxing (33%) and badminton (24%), and lowest in swimming, archery, roller speed skating, equestrian, climbing and rowing (<5%). The highest incidences of illness were recorded in golf (20%), followed by triathlon (16%), beach volleyball and diving (both 14%). Of the illnesses, 50% affected the respiratory system and 15% the gastrointestinal system. Injury and illness incidences varied between continents with athletes representing Europe having significantly fewer injuries and illnesses compared with other continents, apart from a similar illness incidence to Asian athletes. Conclusion: The overall injury incidence of 15.5 injuries per 100 athletes was higher, while the overall illness incidence of 8.4 illnesses per 100 athletes was similar to previous youth and Olympic Games. The new sports did not differ significantly compared with the other sports with respect to injury and illness risk.

• Soligard, Torbjørn; Palmer, Debbie; Steffen, Kathrin; Lopes, Alexandre Dias; Grant, Marie-Elaine & Kim, DooSup [Show all 12 contributors for this article] (2019). Sports injury and illness incidence in the PyeongChang 2018 Olympic Winter Games: a prospective study of 2914 athletes from 92 countries. British Journal of Sports Medicine. ISSN 0306-3674. 53(17), p. 1085–1092. doi: 10.1136/bjsports-2018-100236. Full text in Research Archive Show summary

  Objective To describe the incidence of injuries and illnesses sustained during the XXIII Olympic Winter Games, hosted by PyeongChang on 9–25 February 2018.MethodsWe recorded the daily number of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the PyeongChang 2018 medical staff.resultsIn total, 2914 athletes (1210 women, 42%; 1704 men, 58%) from 92 NOCs were observed for occurrence of injury and illness. NOC and PyeongChang 2018 medical staff reported 376 injuries and 279 illnesses, equalling 12.6 injuries and 9.4 illnesses per 100 athletes over the 17-day period. Altogether, 12% of the athletes incurred at least one injury and 9% at least one illness. The injury incidence was highest in ski halfpipe (28%), snowboard cross (26%), ski cross (25%), snowboard slopestyle (21%) and aerials (20%), and lowest in Nordic combined, biathlon, snowboard slalom, moguls and cross-country skiing (2%–6%). Of the 376 injuries recorded, 33% and 13% were estimated to lead to ≥1day and >7 days of absence from sport,respectively. The highest incidences of illness were recorded in biathlon (15%), curling (14%), bobsleigh (14%) and snowboard slalom (13%). Thirty per cent of the illnesses were expected to result in time loss, and 70% affected the respiratory system. Women suffered 61% more illnesses than men.ConclusionOverall, 12% of the athletes incurred at least one injury during the Games and 9% an illness, incidences that are similar to the Olympic Winter Games of 2010 and 2014.

• Mugele, Hendrik; Plummer, Ashley; Steffen, Kathrin; Stoll, Josefine; Mayer, Frank & Müller, Juliane (2018). General versus sports-specific injury prevention programs in athletes: A systematic review on the effect on injury rates. PLOS ONE. ISSN 1932-6203. 13(10). doi: 10.1371/journal.pone.0205635. Full text in Research Archive Show summary

  Introduction: Annually, 2 million sports-related injuries are reported in Germany of which athletes contribute to a large proportion. Multiple sport injury prevention programs designed to decrease acute and overuse injuries in athletes have been proven effective. Yet, the programs’ components, general or sports-specific, that led to these positive effects are uncertain. Despite not knowing about the superiority of sports-specific injury prevention programs, coaches and athletes alike prefer more specialized rather than generalized exercise programs. Therefore, this systematic review aimed to present the available evidence on how general and sports-specific prevention programs affect injury rates in athletes. Methods: PubMed and Web of Science were electronically searched throughout April 2018. The inclusion criteria were publication dates Jan 2006–Dec 2017, athletes (11–45 years), exercise-based injury prevention programs and injury incidence. The methodological quality was assessed with the Cochrane Collaboration assessment tools. Results: Of the initial 6619 findings, 15 studies met the inclusion criteria. In addition, 13 studies were added from reference lists and external sources making a total of 28 studies. Of which, one used sports-specific, seven general and 20 mixed prevention strategies. Twenty-four studies revealed reduced injury rates. Of the four ineffective programs, one was general and three mixed. Conclusion: The general and mixed programs positively affect injury rates. Sports-specific programs are uninvestigated and despite wide discussion regarding the definition, no consensus was reached. Defining such terminology and investigating the true effectiveness of such IPPs is a potential avenue for future research.

• Räisänen, Anu; Arkkila, Hillevi; Vasankari, Tommi; Steffen, Kathrin; Parkkari, Jari & Kannus, Pekka [Show all 8 contributors for this article] (2018). Investigation of knee control as a lower extremity injury risk factor: A prospective study in youth football. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 28(9), p. 2084–2092. doi: 10.1111/sms.13197. Full text in Research Archive Show summary

  This prospective study in youth football examined the relationship between frontal plane knee projection angle (FPKPA) during the single‐leg squat and sustaining an acute lower extremity injury or acute non‐contact lower extremity injury. Secondly, side‐to‐side asymmetry in FPKPA and sex as injury risk factors were explored. In addition, we investigated the influence of age, sex, and leg dominance on the FPKPA. A total of 558 youth football players (U11 to U14) participated in the single‐leg squat test and prospective injury registration. FPKPA was not found as a risk factor for injuries at this age. There was no difference in the mean FPKPA between sexes. However, FPKPA was associated with age; oldest subjects displayed the smallest FPKPA. Among boys, the frontal plane knee control improved by age. Among girls, the relationship between age and FPKPA was not as clear, but the oldest girls displayed the smallest mean FPKPA in the study (12.2° ± 8.3°). The FPKPA was greater on the dominant kicking leg compared to the non‐dominant support leg (P < .001 for boys, P = .001 for girls). However, side‐to‐side asymmetry in FPKPA was not associated with future injuries. In conclusion, frontal plane knee control in the single‐leg squat was not associated with lower extremity injuries among young football players. As the single‐leg squat to 90° knee flexion was too demanding for many subjects, easier single‐leg squat test procedure or a different movement control test, such as a double‐legged squat, could be more suitable for the young football players.

• Risberg, May Arna; Steffen, Kathrin; Nilstad, Agnethe; Myklebust, Grethe; Kristianslund, Eirik & Moltubakk, Marie M. [Show all 7 contributors for this article] (2018). Normative Quadriceps and Hamstring Muscle Strength Values for Female, Healthy, Elite Handball and Football Players. Journal of Strength and Conditioning Research. ISSN 1064-8011. 32(8), p. 2314–2323. doi: 10.1519/JSC.0000000000002579. Full text in Research Archive Show summary

  This study presents normative values for isokinetic knee extension and flexion muscle strength tests in 350 elite, female, handball (n = 150) and football (n = 200) players. Isokinetic concentric muscle strength tests at 60°·sec−1 were recorded bilaterally using a dynamometer. Peak torque (in Newton meter [N·m]), body mass normalized peak torque (N·m·kg−1), and hamstring to quadriceps ratio (H:Q ratio) for dominant and nondominant legs were recorded. The female elite players were 20.9 ± 4.0 years, started playing at the elite level at the age of 18.2 ± 2.7 years, with a mean of 9.7 ± 2.2 hours of weekly in-season training. Handball players demonstrated greater quadriceps muscle strength compared with football players (11.0%) (p < 0.001), also when normalized to body mass (4.1%) (p = 0.012), but not for weight-adjusted hamstring muscle strength. The H:Q ratio was higher on the dominant compared with the nondominant leg for handball players only (p = 0.012).The H:Q ratio was significantly lower for handball players (0.58) compared with football players (0.60) (p < 0.02). These normative values for isokinetic knee extension and flexion torques of healthy, elite, female handball and football players can be used to set rehabilitation goals for muscle strength after injury and enable comparison with uninjured legs. Significantly greater quadriceps muscle strength was found for handball players compared with football players, also when normalized to body mass.

• Pensgaard, Anne Marte; Ivarsson, Andreas; Nilstad, Agnethe; Solstad, Bård Erlend & Steffen, Kathrin (2018). Psychosocial stress factors, including the relationship with the coach, and their influence on acute and overuse injury risk in elite female football players. BMJ Open sport & exercise medicine. ISSN 2055-7647. 4(1). doi: 10.1136/bmjsem-2017-000317. Full text in Research Archive Show summary

  Background: The relationship between specific types of stressors (eg, teammates, coach) and acute versus overuse injuries is not well understood. Objective: To examine the roles of different types of stressors as well as the effect of motivational climate on the occurrence of acute and overuse injuries. Methods: Players in the Norwegian elite female football league (n=193 players from 12 teams) participated in baseline screening tests prior to the 2009 competitive football season. As part of the screening, we included the Life Event Survey for Collegiate Athletes and the Perceived Motivational Climate in Sport Questionnaire (Norwegian short version). Acute and overuse time-loss injuries and exposure to training and matches were recorded prospectively in the football season using weekly text messaging. Data were analysed with Bayesian logistic regression analyses. Results: Using Bayesian logistic regression analyses, we showed that perceived negative life event stress from teammates was associated with an increased risk of acute injuries (OR=1.23, 95% credibility interval (1.01 to 1.48)). There was a credible positive association between perceived negative life event stress from the coach and the risk of overuse injuries (OR=1.21, 95% credibility interval (1.01 to 1.45)). Conclusions: Players who report teammates as a source of stress have a greater risk of sustaining an acute injury, while players reporting the coach as a source of stress are at greater risk of sustaining an overuse injury. Motivational climate did not relate to increased injury occurrence.

• Soligard, Torbjørn; Steffen, Kathrin; Palmer, Debbie; Alonso, Juan Manuel; Bahr, Roald & Lopes, Alexandre Dias [Show all 14 contributors for this article] (2017). Sports injury and illness incidence in the Rio de Janeiro 2016 Olympic Summer Games: A prospective study of 11274 athletes from 207 countries. British Journal of Sports Medicine. ISSN 0306-3674. 51(17), p. 1265–1271. doi: 10.1136/bjsports-2017-097956. Full text in Research Archive
• Edouard, Pascal; Steffen, Kathrin; Junge, Astrid; Leglise, Michel; Soligard, Torbjørn & Engebretsen, Lars (2017). Gymnastics injury incidence during the 2008, 2012 and 2016 Olympic Games: analysis of prospectively collected surveillance data from 963 registered gymnasts during Olympic Games. British Journal of Sports Medicine. ISSN 0306-3674. 52(7), p. 475–481. doi: 10.1136/bjsports-2017-097972. Show summary

  Objective To determine the incidence and characteristics of injuries in female and male gymnastics disciplines (artistic, rhythmic and trampoline) during three Olympic Games with a view to ultimately improving injury prevention. Methods The National Olympic Committee’s head physicians and the medical teams of the Local Organising Committee of the Olympic Games reported daily the occurrence (or non-occurrence) of newly sustained injuries in artistic, rhythmic and trampoline gymnastics on a standardised report form during the 2008, 2012 and 2016 Summer Olympic Games. Results During the three Olympic Games, 81 injuries were reported in a total of 963 registered gymnasts, corresponding to an incidence of 84 injuries (95% CI 67 to 102) per 1000 registered gymnasts, with no difference in injury incidence between female and male gymnasts. Thirty-eight per cent of injuries led to time-loss from sport. The most frequent injury location and injury type were the ankle (22%) and sprain (35%), respectively. The most common diagnosis was ankle sprain (14% of all injuries and 23% of time-loss injuries). The injury incidence was highest in female (107±35) and male artistic gymnastics (83±32), followed by female rhythmic gymnastics (73±30), and lower in male (63±69) and female (43±43) trampoline gymnastics. Conclusions Research should focus on preventing injuries in artistic gymnastics and of the condition of ankle sprain. Injury surveillance studies should be continued during major championships and throughout the entire competitive season as the Olympic Games provides only a snapshot (although an important one).

• Wedege, Pia; Steffen, Kathrin; Strøm, Vegard & Opheim, Arve Isak (2017). Reliability of three-dimensional kinematic gait data in adults with spinal cord injury. Journal of Rehabilitation and Assistive Technologies Engineering. ISSN 2055-6683. 4, p. 1–10. doi: 10.1177/2055668317729992. Show summary

  Objectives: Three-dimensional gait analysis has been recommended as part of standardized gait assessment in people with spinal cord injury. The aim was to investigate inter- and intra-session reliabilities of gait kinematics in people with spinal cord injury. Methods: Fifteen adults with spinal cord injury performed two test sessions on separate days. Six infrared cameras, 16 reflective markers and the Plug-in gait model were used. For each subject, five gait trials from both sessions were included. The Gait Profile Score and the Gait Variable Score were used as kinematic outcome measures. Reliability was assessed with intraclass correlation coefficient, standard error of measurement, minimal detectable change, and Bland–Altman plots. Results: Inter-session intraclass correlation coefficient for all variables was >0.82 and standard error of measurement <1.8°, except for hip rotation. Intra-session reliability was found to be high (≥0.78) and slightly better than that for inter-session. Minimal detectable change for all variables was <4.7°, except for hip rotation. Conclusions: The high inter- and intra-session reliabilities indicate small intrinsic variation of gait. Thus, three-dimensional gait analysis seems to be a reliable tool to evaluate kinematic gait in adults with spinal cord injury, but caution is warranted especially for hip rotation evaluation.

• Kubosch, Eva J.; Fassbender, Katharina; Steffen, Kathrin; Kubosch, David; Südkamp, Norbert P. & Hirschmüller, Anja (2017). Implementation eines Injury and Illness Surveillance Systems im paralympischen Leistungssport – Machbarkeitsstudie am Beispiel des Nationalkaders Radsport. Sports Orthopaedics and Traumatology. ISSN 0949-328X. doi: 10.1016/j.orthtr.2017.02.003. Full text in Research Archive Show summary

  Hintergrund: Die Bedeutung eines standardisierten Monitoring Systems von Erkrankungen und Verletzungen bei Leistungssportlern wurde in den letzten Jahren vielfach betont. Trotz der zunehmenden Trainings- und Wettkampfbelastung von paralympischen Athleten stellt das kontinuierliche Gesundheits- Monitoring im Behindertensport eine Rarität dar. Das Ziel der vorliegenden Studie war die Prüfung der Machbarkeit und Auswertung eines Injury und Illness Surveillance Systems (IISS) in der deutschen Paracycling Nationalmannschaft während der Vorbereitungsphase auf die paralympischen Spiele in Rio de Janeiro 2016. Material und Methoden: Über einen Zeitraum von 24 Wochen wurde mittels eines validierten Online-Fragebogens wöchentlich der Gesundheitsstatus des deutschen Paracycling Nationalkaders von Oktober 2015 bis März 2016 erfasst. Der Oslo Sports Trauma Research Centre (OSTRC) Fragebogen hat sich als valide und reliabel im Monitoring von akuten Verletzungen und Erkrankungen sowie Überlastungsbeschwerden gezeigt. Das Auftreten von Verletzungen und Erkrankungen, Trainingsausfallzeiten, die Einschränkung der Leistungsfähigkeit sowie der aktuelle Trainingsumfang wurden erhoben. Ergebnisse: 24 der 26 Kaderathleten des paralympischen Radsports wurden nach schriftlicher Einwilligung in die Studie eingeschlossen. Das Durchschnittsalter betrug 36,5 +- 9,7 Jahre. Die Rücklaufquote der Fragebögen betrug 93%. 30 Erkrankungen und 27 Verletzungen wurden während 24 Wochen erfasst. Am häufigsten wurden Verletzungen der Schulter, des Handgelenkes sowie des Kniegelenkes dokumentiert. Die häufigsten Erkrankungen stellten Infekte der oberen Atemwege sowie grippale Infekte im Gesamtkollektiv und Harnwegsinfekte bei querschnittsgelähmten Athleten dar. Insgesamt entstanden im Kollektiv 140 Trainingsausfalltage, davon 27 durch Verletzungen und 111 durch Krankheiten. Das Surveillance-Programm zeigte eine hohe Akzeptanz bei den Athleten. Schlussfolgerungen: Ein IISS zur systematischen Erhebung von Verletzungen und Erkrankungen konnte am Kollektiv der deutschen Paracycling Nationalmannschaft bei hoher Zufriedenheit der Sportler und guter Rücklaufquote erfolgreich etabliert werden. Mit der Identifikation von Verletzungsmechanismen und Risikofaktoren behinderter Athleten sollten sportartspezifische Präventionsmaßnahmen abgeleitet werden.

• Steffen, Kathrin; Nilstad, Agnethe; Krosshaug, Tron; Pasanen, Kati; Killingmo, Aleksander & Bahr, Roald (2017). No association between static and dynamic postural control and ACL injury risk among female elite handball and football players: a prospective study of 838 players. British Journal of Sports Medicine. ISSN 0306-3674. 51(4), p. 253–259. doi: 10.1136/bjsports-2016-097068. Show summary

  Background: Research on balance measures as potential risk factors for ACL injury is limited. Objective: To assess whether postural control was associated with an increased risk for ACL injuries in female elite handball and football players. Method: Premier league players were tested in the preseason and followed prospectively for ACL injury risk from 2007 through 2015. At baseline, we recorded player demographics, playing experience, ACL and ankle injury history. We measured centre of pressure velocity in single-leg stabilisation tests and reach distances in the Star Excursion Balance Test. To examine the stability of postural control measures over time, we examined their short-term and long-term reproducibility. We generated logistic regression models, 1 for each of the proposed risk factors. Results: A total of 55 (6.6%) out of 838 players (age 21±4 years; height 170±6 cm; body mass 66±8 kg) sustained a non-contact ACL injury after baseline testing (1.8±1.8 years). When comparing normalised balance measures between injured and uninjured players in univariate analyses, none of the variables were statistically associated with ACL injury risk. Short-term and long-term reproducibility of the selected variables was poor. Players with a previous ACL injury had a 3-fold higher risk of sustaining a new ACL injury compared with previously uninjured players (OR 2.9, CI 1.4 to 5.7). Conclusions: None of postural control measures examined were associated with increased ACL injury risk among female elite handball and football players. Hence, as measured in the current investigation, the variables included cannot be used to predict ACL injury risk.

• Myklebust, Grethe; Bahr, Roald; Nilstad, Agnethe & Steffen, Kathrin (2017). Knee function among elite handball and football players 1 to 6 years after anterior cruciate ligament injury. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 27(5), p. 545–553. doi: 10.1111/sms.12842. Show summary

  The aim of the study was to describe objective and self-reported knee function for athletes who have returned to elite handball and football play after an ACL injury, comparing these to non-injured players at the same level. A total of 414 handball and 444 football players completed baseline tests from 2007 through 2014, examining lower extremity strength, dynamic balance, knee laxity, and knee function (KOOS questionnaire). Measures were compared between injured and non-injured legs, and between injured legs and legs of controls. Eighty (9.3%) of the 858 players reported a previous ACL injury, 1 to 6 yrs post-injury (3.5±2.5 yrs), 49 handball (61.3%) and, 31 football players (38.7%). We found no difference in strength or dynamic balance between previously ACL-injured (N=80) and non-injured players legs (N=1556). However, lower quadriceps (6.3%, 95% CI: 3.2 to 9.2) and hamstrings muscle strength (6.1%, 95% CI: 3.3 to 8.1) was observed in previously ACL-injured legs compared to the non-injured contralateral side (N=80). ACL-injured knees displayed greater joint laxity than for the contralateral knee (N=80, 17%, 95% CI: 8 to 26) and healthy knees (N=1556, 23%, 95% CI: 14 to 33). KOOS scores were significantly lower for injured knees compared to knees of non-injured players. ACL-injured players who have successfully returned to elite sport have comparable strength and balance measures as their non-injured teammates. Subjective perception of knee function is strongly affected by injury history, with clinically relevant lower scores for the KOOS sub-scores Pain, Function, Sport and Quality Of Life.

• Hirschmüller, Anja; Steffen, Kathrin; Fassbender, Katharina; Clarsen, Benjamin; Leonhard, R. & Konstantinidis, Lukas [Show all 8 contributors for this article] (2017). German translation and content validation of the OSTRC Questionnaire on overuse injuries and health problems. British Journal of Sports Medicine. ISSN 0306-3674. 51(4), p. 260–263. doi: 10.1136/bjsports-2016-096669. Show summary

  Objective: The aim of this study was to translate, culturally adapt and validate the Oslo Sports Trauma Research Centre (OSTRC) Questionnaire on Health Problems into the German context. Methods: A slightly modified back-translation method was used to translate the questionnaire. Validation was done in 24 high-level Paralympic athletes followed over 20 consecutive weeks. Results: The translated version of the questionnaire showed a very high internal consistency and good test–retest reliability (Cronbach's α 0.92, intraclass correlation coefficient 0.91). Additionally, we observed high acceptance and compliance from our cohort of athletes, whose mean weekly response rate was 91.5%. Overall, 114 training days were lost because of illness or injury within the 20 weeks and, on average, 5 athletes per week (20.8%) reported health problems. Conclusions: This study demonstrates that the translated German version of the OSTRC Questionnaire is a reliable and valid tool with high internal consistency for the medical monitoring of German athletes. The OSTRC-G now offers the opportunity for a continued surveillance of high-level German athletes.

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• Soligard, Torbjørn; Steffen, Kathrin; Budgett, Richard & Engebretsen, Lars (2024). Development of sports medicine in the International Olympic Committee. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2024-108201.
• Kamatsuki, Yusuke; Qvale, Marie Synnøve; Wangensteen, Arnlaug; Steffen, Kathrin & Krosshaug, Tron (2024). Anatomical risk factors for primary and secondary non-contact ACL injury – a prospective cohort study in 880 female elite players.
• Steffen, Kathrin (2023). Perspektiven der sportmedizinischen Betreuung von Freizeit- und Spitzensportlern mit Behinderungen im internationalen Erfahrungsaustausch.
• Steffen, Kathrin (2022). Implemenring injury prevention research into practice_the Norwegian model_Sports 4 more.
• Steffen, Kathrin (2022). Sports-related eye injuries during Olympic Games.
• Steffen, Kathrin (2022). Injury + illness surveillance in elite para sports.
• Steffen, Kathrin; Berge, Hilde Moseby & Haugvad, Lars (2022). Optimal health - the Norwegian health evaluation and monitoring program.
• Steffen, Kathrin (2022). Skader og sykdom i paraidrett og forebyggende tiltak.
• Steffen, Kathrin (2022). Benefits of health screening for Norwegian Paralympic and Olympic athletes.
• Steffen, Kathrin & Haugvad, Lars (2022). Health monitoring program.
• Palmer, Debbie; Cooper, Dale; Emery, Carolyn; Bratt, Mark; Engebretsen, Lars & Scammell, Brigitte [Show all 10 contributors for this article] (2021). Olympic-career related sports injury epidemiology - the retired olympian musculoskeletal health study (ROMHS). British Journal of Sports Medicine. ISSN 0306-3674. 55, p. A24–A25. doi: 10.1136/bjsports-2021-IOC.56.
• Hirschmüller, Anja; Fassbender, Katharina; Kubosch, Johanna; Leonhart, Rainer & Steffen, Kathrin (2021). The importance of health monitoring in competitive para athletes - results of the German injury and illness surveillance system. British Journal of Sports Medicine. ISSN 0306-3674. 55. doi: 10.1136/bjsports-2021-IOC.73.
• Steffen, Kathrin (2021). Injury and illness in Olympic winter sports , protection of the athlete .
• Steffen, Kathrin (2021). How can injury and illness surveillance of elite athletes help in a daily clinical setting.
• Steffen, Kathrin (2021). Long term surveillance to promote athlete health and performance - the Norwegian health team experiences.
• Palmer, Debbie; Cooper, Dale J.; Emery, Carolyn; Batt, Mark E.; Engebretsen, Lars & Scammell, Brigitte E. [Show all 10 contributors for this article] (2021). The Retired Olympian Musculoskeletal Health Study (ROMHS) cohort: recruitment of 3,357 Olympians and 1,735 general population controls.
• Hirschmüller, Anja; Fassbender, Katharina; Kubosch, Johanna; Leonhart, Rainer & Steffen, Kathrin (2021). The importance of health monitoring in competitive para athletes: results of the German injury and illness surveillance system.
• Palmer, Debbie; Cooper, Dale J.; Emery, Carolyn; Batt, Mark E.; Engebretsen, Lars & Scammell, Brigitte E. [Show all 10 contributors for this article] (2021). Olympic-career related sports injury epidemiology: The Retired Olympian Musculoskeletal Health Study (ROMHS).
• Steffen, Kathrin (2021). GET SET – the IOC/OSTRC app: The importance of user involvement.
• Steffen, Kathrin (2021). Sykdom og skader hos paralympiske utøvere - hvor trykker skoen mest?
• Steffen, Kathrin (2021). ParaFRISK – optimal helse for mennesker med funksjonsnedsetting!
• Steffen, Kathrin (2021). Injury and illness surveillance in elite athletes.
• Steffen, Kathrin (2021). Skader, sykdom og forebygging i paraidrett. Fysisk aktivitet og funksjonshemming.
• Steffen, Kathrin (2020). Keep our para athletes healthy - Injury and illness surveillance, our Norwegian experience.
• Edouard, Pascal; Steffen, Kathrin; Navarro, Laurent; Mansournia, Mohammad Ali & Nielsen, Rasmus Østergaard (2020). Methods matter: dealing with low compliance in sports injury trials analyses using instrumental variable analysis. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2020-102155.
• Steffen, Kathrin (2019). Das Kreuzband-Verletzungsrisiko bei Ballsportarten im Hochleistungssport der Frauen – macht sich der große Einsatz des Screenings bezahlt? Evidenzbasierte Prävention & Therapie.
• Bahr, Roald; Engebretsen, Lars; Myklebust, Grethe & Steffen, Kathrin (2019). Halvparten av idrettsskadene kan enkelt forebygges. [Newspaper]. Aftenposten.
• Steffen, Kathrin (2019). Skadefri - en ressurs for deg som fastlege. Utposten. ISSN 0800-5680. p. 15–19.
• Steffen, Kathrin (2018). Omtrent halvparten av idrettsskadene kan forebygges. [Internet]. NIH-blogg.
• Steffen, Kathrin (2018). Halvparten av alle idrettsskader kan forebygges. [Newspaper]. DN+.
• Engebretsen, Lars & Steffen, Kathrin (2018). Injury and illness surveillance.
• Steffen, Kathrin (2018). Injury and illness surveillance during Olympic Games - behind the scene.
• Steffen, Kathrin (2018). National and international multimedia projects to disseminate knowledge in sports medicine and associated challenges.
• Steffen, Kathrin (2018). Ti øvelser som gjør ballspillere mindre utsatt for skader. [Internet]. Aftenposten - Sprek.
• Steffen, Kathrin (2018). Get Set-Train Smarter - a free IOC app on injury prevention.
• Steffen, Kathrin (2018). IOC Physiotherapy and sport science symposium - Introduction.
• Steffen, Kathrin (2018). BJSM - how can it help you and how can you use it?
• Steffen, Kathrin (2018). Injury & Illness surveillance during Olympic Games - behind the scene.
• Soligard, Torbjørn; Steffen, Kathrin; Palmer, Debbie; Alonso, Juan-Manuel; Bahr, Roald & Lopes, Alexandre Dias [Show all 14 contributors for this article] (2018). Infographic: Injury and illness, the 2016 Olympic Games. British Journal of Sports Medicine. ISSN 0306-3674. doi: 10.1136/bjsports-2018-099090.
• Edouard, Pascal; Cugy, Emmanuelle; Dolin, Romain; Morel, Nicolas & Steffen, Kathrin (2017). Preventive effect of an Athletics Injury Prevention Program on injury complaints with decreased participation in athletics - A pilot prospective cohort study. British Journal of Sports Medicine. ISSN 0306-3674. 51(4).
• Edouard, Pascal; Cugy, Emmanuelle; Dolin, Romain; Morel, Nicolas & Steffen, Kathrin (2017). Preventive effect of an Athletics Injury Prevention Program on injury complaints with decreased participation in athletics - A pilot prospective cohort study.
• Steffen, Kathrin (2017). BJSM - how can it help you and how can you use it?
• Soligard, Torbjørn; Steffen, Kathrin; Palmer, Debbie; Alonso, Juan Manuel; Bahr, Roald & Lopes, Alexandre Dias [Show all 14 contributors for this article] (2017). Sports injury and illness incidence in the Rio de Janeiro 2016 Olympic Summer Games - a prospective study of 11274 athletes from 207 countries. In Lorentzen, Karl-Ivar (Eds.), Høstmøteboken - Vitenskapelig program og abstract 2017. Norsk ortopedisk forening.
• Soligard, Torbjørn; Steffen, Kathrin; Palmer, Debbie; Alonso, Juan Manuel; Bahr, Roald & Lopes, Alexandre Dias [Show all 14 contributors for this article] (2017). Sports injury and illness incidence in the Rio de Janeiro 2016 Olympic Summer Games - a prospective study of 11274 athletes from 207 countries.
• Steffen, Kathrin (2017). Sports injuries and illnesses in the Lillehammer 2016 Youth Olympic Winter Games .
• Steffen, Kathrin (2017). Multimedia tools to prevent sports injury - translation to the field of play.
• Steffen, Kathrin (2017). No association between static and dynamic postural control and ACL injury risk among female elite handball and football players.
• Steffen, Kathrin (2017). Forskning + Formidling = Skadefri - Hvordan holde seg skadefri i svømming v/skadefri.no.
• Steffen, Kathrin (2017). Forskning + formidling = Skadefri. Dansk sportsmedicin. ISSN 1397-4211. 21(3), p. 23–24.
• Steffen, Kathrin (2017). BJSM update.
• Steffen, Kathrin (2017). IOC Sports injury prevention and surveillance.
• Steffen, Kathrin; Moseid, Christine Holm; Engebretsen, Lars; Søberg, Pia K.; Amundsen, Olav & Holm, Kristian [Show all 8 contributors for this article] (2017). Sports injuries and illnesses in the Lillehammer 2016 Youth Olympiv Winter Games. British Journal of Sports Medicine. ISSN 0306-3674. 51(4).
• Steffen, Kathrin; Moseid, Christine Holm; Engebretsen, Lars; Søberg, Pia K.; Amundsen, Olav & Holm, Kristian [Show all 8 contributors for this article] (2017). Sports injuries and illnesses in the Lillehammer 2016 Youth Olympiv Winter Games.
• Kubosch, Eva J.; Fassbender, Katharina; Steffen, Kathrin; Südkamp, Norbert P. & Hirschmüller, Anja (2017). Implementation of an injury and illness surveillance system in Paralympic athletes (ISSPA) - a study in German paracycling athletes. British Journal of Sports Medicine. ISSN 0306-3674. 51(4).
• Kubosch, Eva J.; Fassbender, Katharina; Steffen, Kathrin; Südkamp, Norbert P. & Hirschmüller, Anja (2017). Implementation of an injury and illness surveillance system in Paralympic athletes (ISSPA) - a study in German paracycling athletes.
• Hirschmüller, Anja; Steffen, Kathrin; Fassbender, Katharina; Clarsen, Benjamin; Leonhard, Reiner & Konstantinidis, Lukas [Show all 8 contributors for this article] (2017). German translation and content validation of the ostrc questionnaire on overuse injuries and health problems.
• Steffen, Kathrin; Nilstad, Agnethe; Krosshaug, Tron; Pasanen, Kati & Bahr, Roald (2017). No association between static and dynamic postural control and ACL injury risk among female elite handball and football players. British Journal of Sports Medicine. ISSN 0306-3674. 51(4).
• Steffen, Kathrin; Nilstad, Agnethe; Krosshaug, Tron; Pasanen, Kati & Bahr, Roald (2017). No association between static and dynamic postural control and ACL injury risk among female elite handball and football players.
• Krosshaug, Tron; Pasanen, Kati; Steffen, Kathrin; Mok, Kam-Ming; Bencke, Jesper & Zebis, Mette (2017). Panel discussion: How do we improve current ACL injury prevention programs?
• Steffen, Kathrin (2017). Is lower extremity muscle strength associated with ACL injury risk?
• Engen, Rune & Steffen, Kathrin (2020). Kartlegging av kunnskap om idrettsskader og implementering av skadeforebyggende tiltak i treningen blant fotballtrenere på klubbnivå for spillere i alderen 6-19 år. Norges idrettshøgskole.

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