Injuries and illnesses related to dinghy-sailing on hydrofoiling boats

Paiano R., Feletti F., Tarabini M., Buzzacott P.

Bahr R., Clarsen B., Derman W., Dvorak J., Emery C.A., Finch C.F., Hägglund M., Junge A., Kemp S., Khan K.M., Marshall S.W., Meeuwisse W., Mountjoy M., Orchard J.W., Pluim B., et. al.

Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport-specific or setting-specific consensus statements on sports injury (and, eventually, illness) epidemiology to date. Our objective was to further strengthen consistency in data collection, injury definitions and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups and a 3-day consensus meeting in October 2019. This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems; severity of health problems; capturing and reporting athlete exposure; expressing risk; burden of health problems; study population characteristics and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE Extension—the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). The IOC encourages ongoing in- and out-of-competition surveillance programmes and studies to describe injury and illness trends and patterns, understand their causes and develop measures to protect the health of the athlete. Implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.

Clarsen B., Bahr R., Myklebust G., Andersson S.H., Docking S.I., Drew M., Finch C.F., Fortington L.V., Harøy J., Khan K.M., Moreau B., Moore I.S., Møller M., Nabhan D., Nielsen R.O., et. al.

In 2013, the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O) was developed to record the magnitude, symptoms and consequences of overuse injuries in sport. Shortly afterwards, a modified version of the OSTRC-O was developed to capture all types of injuries and illnesses—The Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H). Since then, users from a range of research and clinical environments have identified areas in which these questionnaires may be improved. Therefore, the structure and content of the questionnaires was reviewed by an international panel consisting of the original developers, other user groups and experts in sports epidemiology and applied statistical methodology. Following a review panel meeting in October 2017, several changes were made to the questionnaires, including minor wording alterations, changes to the content of one question and the addition of questionnaire logic. In this paper, we present the updated versions of the questionnaires (OSTRC-O2 and OSTRC-H2), assess the likely impact of the updates on future data collection and discuss practical issues related to application of the questionnaires. We believe this update will improve respondent adherence and improve the quality of collected data.

Feletti F., Brymer E.

The purpose of this descriptive, epidemiological study is to classify injury patterns and determine dynamics of injuries, possible causes and preventive measures. A questionnaire was filled in by 127 kite buggying enthusiasts in 17 countries. Injuries were classified by type and anatomical site. Incident causes were analysed using the Haddon matrix. Injuries classified as moderate or severe (AIS score ≥ 2) were sustained by 26% of kite buggy enthusiasts. The most common incident dynamic (61.8%) was the OBE (an acronym for ‘out-of-buggy experience’). Causal factors were largely equipment-related (42.3%), with remaining incidents being equally attributable to environmental and human factors. While upper and lower limbs were equally involved in incidents, the most frequently affected anatomical site was the shoulder (23%). Kite buggying can be considered a sport with the potential for serious injury. Injury prevention in this sport needs to be approached from several angles and should include the development and adoption of automatic release systems and shoulder guards, the establishment of formal training programs covering the subject of meteorology and the establishment of secure, designated kite buggying areas. Findings from this study are important for two reasons. First, they demonstrate the significance of understanding specific sports when considering health and safety, and second, the study provides specific data for the fast growing extreme sport of kite buggying.

Feletti F., Aliverti A.

Many features allow modern sailing to take place alongside other extreme sports, and these in particular mean challenging the laws of nature, pushing technology to the limit, spectacularity, and the need for its participants to possess technical skills and competencies in addition to physical fitness. The various sailing classes greatly vary in the demands they place on athletes, putting sailing crews at risk of different types of injuries and illnesses. Both recreational and novice dinghy sailors report mainly acute injuries: that are, in particular, head contusions from hitting the boom and spinnaker pole, cuts and lacerations to the hands and knee contusions due to falls and collisions with equipment. At the other extreme, prevailing injuries among Olympic-class athletes tend to overuse injuries, in particular, to the back and knees, due to specific activities such as hikingand also to a poor balance between work and recovery time. In America’s Cup crews, grinders, mastmen, and bowmen are mainly prone to injuries, that are mainly muscle contractures, tendinopathies, and sprains to the upper limbs and back. Intense training, psychological stress, cold and damp also expose these sailors to upper respiratory tract infections. In offshore and oceanic yacht racing, a large rate of medical conditions consists ofillnesses, that mainly affect the urinary and gastrointestinal tract and the skin. Acute injuries may be favoured by severe fatigue and sleep loss, especially during solo races.

Tan B., Leong D., Vaz Pardal C., Lin C.Y., Kam J.W.

Background/aim The Sailing World Championships 2014 was contested by 1167 sailors in all 10 Olympic classes. Our objective was to characterise sailing-related injuries and illnesses in sailors participating in this regatta.Methods We conducted 2 surveys: (1) prior to the World Championships, sailors answered a 12-month recall questionnaire on sailing-related injuries and illnesses and (2) during the Championships, injuries and illnesses were documented.Results There were 760 respondents (65% of all participants) for the 12-month recall questionnaire (58% male, 42% female), of whom 244 participants reported 299 injuries (0.59 injuries per 1000 h of sailing). Injuries were most prevalent in the 49erFX (64%), RS:X Women (39%), 49er (37%) and Nacra 17 (36%). Lower back (29% of sailors), knee (13%), shoulder (12%) and ankle (10%) injuries were most prevalent; most (58% of all injuries) were overuse injuries; and 56% of sailors lost sailing time. Most illnesses (40%) were infections, primarily of the respiratory system (43%). During the Championships, there were 67 injuries (4 per 1000 days of sailing). The 49er (24% of all injuries), 470 Men and Women (24%), and 49erFX (19%) had the highest incidence. Injuries to the hand/fingers (22% of all injuries), back (18%), and foot (12%) were most common, as were contusions (37% of all injuries), cuts/lacerations (24%), and sprains (9%). Of the 29 illnesses (2 per 1000 days of sailing), 9 (31%) were gastrointestinal and 6 (21%) respiratory, while 2 (7%) were gout attacks.Conclusions The Olympic classes introduced since 2000 (49erFX, 49er, Nacra 17) have resulted in a rise in injuries.

Ryan K.M., Nathanson A.T., Baird J., Wheelhouse J.

Prior sailing injury studies have been small, focused investigations. This large, population-based study examined the mechanisms and factors contributing to sailboat-related injuries and deaths.A retrospective data analysis of the Boating Accident Report Database compiled by the US Coast Guard between 2000 and 2011 was performed. The database was analyzed looking at frequency of events. For each subgroup, proportions were determined and 95% CIs were calculated. These data, used in conjunction with the 2011 US Coast Guard National Recreational Boating Survey, were used to estimate a fatality rate.Two hundred seventy-one sailing-related fatalities and 841 injuries were reported. A fatality rate was calculated at 1.19 deaths per million sailing person-days. Weather or hazardous waters were listed as primary contributing factors in 28.0% (95% CI, 22.7-33.4) of deaths; 70.1% (95% CI, 64.7-75.6) of deaths occurred after falling overboard or capsizing. Drowning was the most common cause of death (73.1%; 95% CI, 67.8-78.4), and 81.6% of victims were not wearing a life jacket. Alcohol intoxication contributed to 12.2% (95% CI, 8.3-16.1) of deaths. Operator- or passenger-preventable factors contributed to 52.7% (95% CI, 49.3-56.1) of all injuries; 51.6% (95% CI, 46.1-57.1) of injuries on nonmotorized sailboats were the result of capsizing, and 46.4% (95% CI, 42.1-50.7) of all injuries on motorized sailboats were the result of collisions or grounding.The calculated fatality rate is similar to that of alpine skiing. Falls overboard and capsizing were the most common fatal accidents. Operator inattention, inexperience, and alcohol use were common preventable factors contributing to fatal and nonfatal injury.

Clarsen B., Rønsen O., Myklebust G., Flørenes T.W., Bahr R.

Background Little information exists on the illness and injury patterns of athletes preparing for the Olympic and Paralympic Games. Among the possible explanations for the current lack of knowledge are the methodological challenges faced in conducting prospective studies of large, heterogeneous groups of athletes, particularly when overuse injuries and illnesses are of concern.Objective To describe a new surveillance method that is capable of recording all types of health problems and to use it to study the illness and injury patterns of Norwegian athletes preparing for the 2012 Olympic and Paralympic Games.Methods A total of 142 athletes were monitored over a 40-week period using a weekly online questionnaire on health problems. Team medical personnel were used to classify and diagnose all reported complaints.Results A total of 617 health problems were registered during the project, including 329 illnesses and 288 injuries. At any given time, 36% of athletes had health problems (95% CI 34% to 38%) and 15% of athletes (95% CI 14% to 16%) had substantial problems, defined as those leading to moderate or severe reductions in sports performance or participation, or time loss. Overuse injuries represented 49% of the total burden of health problems, measured as the cumulative severity score, compared to illness (36%) and acute injuries (13%).Conclusions The new method was sensitive and valid in documenting the pattern of acute injuries, overuse injuries and illnesses in a large, heterogeneous group of athletes preparing for the Olympic and Paralympic Games.

Clarsen B., Myklebust G., Bahr R.

Background Current methods for injury registration in sports injury epidemiology studies may substantially underestimate the true burden of overuse injuries due to a reliance on time-loss injury definitions.Objective To develop and validate a new method for the registration of overuse injuries in sports.Methods A new method, including a new overuse injury questionnaire, was developed and validated in a 13-week prospective study of injuries among 313 athletes from five different sports, cross-country skiing, floorball, handball, road cycling and volleyball. All athletes completed a questionnaire by email each week to register problems in the knee, lower back and shoulder. Standard injury registration methods were also used to record all time-loss injuries that occurred during the study period.Results The new method recorded 419 overuse problems in the knee, lower back and shoulder during the 3-month-study period. Of these, 142 were classified as substantial overuse problems, defined as those leading to moderate or severe reductions in sports performance or participation, or time loss. Each week, an average of 39% of athletes reported having overuse problems and 13% reported having substantial problems. In contrast, standard methods of injury registration registered only 40 overuse injuries located in the same anatomical areas, the majority of which were of minimal or mild severity.Conclusion Standard injury surveillance methods only capture a small percentage of the overuse problems affecting the athletes, largely because few problems led to time loss from training or competition. The new method captured a more complete and nuanced picture of the burden of overuse injuries in this cohort.

Nathanson A.T., Baird J., Mello M.

The purpose of this study was to describe the relative frequency, patterns, and mechanisms of sailing-related injuries in dinghies and keelboats. Data were also collected on risky and risk-averse behaviors of sailors, as well as on sailing-related illnesses.A web-based, logic-driven, multiple-choice survey was developed and links were posted on sailing-related websites. Data were collected from March through November 2006 on any injuries or illnesses sailors sustained over the prior 12 months.From 1188 respondents, a total of 1715 injuries and 559 illnesses was reported. The top 3 injuries for keel boats were leg contusions (11%), hand lacerations (8%), and arm contusions (6%), and in dinghies they were leg contusions (13%), knee contusions (6%), and leg lacerations (6%). The most common mechanisms of injury were "trip/fall," "hit by object," and "caught in lines." Tacking, heavy weather, and jibing were the most common factors contributing to injury. The rates of injury and severe injury in this internet-based survey were 4.6 and 0.57 per 1000 days of sailing, respectively. Of the 70 severe injuries, 25% were fractures, 16% were torn tendons or cartilage, 14% were concussions, and 8% were dislocations. The median rate of lifejacket use was 30%, and median rate of sunscreen use was 80%. Sixteen percent of sailors reported sunburn over the prior 12 months. Seven percent of sailors reported use of alcohol within the 2 hours preceding injury.The most common injuries in both keel boats and dinghies are soft-tissue injuries to the extremities. Severe injuries and illnesses in sailing are uncommon in this study population.

HADALA M., BARRIOS C.

To analyze the effectiveness in reducing the number of sport injuries after application of different strategies of preventive physiotherapy during competition periods in an America's Cup yachting crew.A prospective physiotherapy intervention study during competition periods for three seasons was conducted on an America's Cup yachting race crew of 30 professional sailors. In the first two acts (2004), athletes did not receive any preventive physiotherapy. In the two acts celebrated in 2005, preventive intervention (phase 1) consisted of stretching exercises before the yacht race and preventative taping. During the four acts corresponding to the 2006 season, the physiotherapy program was implemented adding articular mobilization before competition, ice baths after competition, and kinesiotaping (phase 2). In the last act and the Louis Vuitton Cup (2007), a recovery program with "core stability" exercises, postcompetition stretching exercises, and 12 h of compressive clothing were added (phase 3).In the preintervention phase (2004), the rate of injured sailors/competition day was 1.66, decreasing to 0.60 in 2007 (phase 3). The number of athletes with more than one injury was significantly reduced from 53% (8 of 15) to 6.5% (2 of 12). In the preintervention period, mastmen, grinders, and bowmen showed a rate of 2.88 injuries per competition day. After phase 3, this group only suffered 0.35 injuries per competition day.The implementation of a program of preventive physiotherapy decreased the risk of injuries suffered during competition by an America's Cup yacht crew.

Neville V., Folland J.P.

Sailors are at risk of injury and an understanding of the risks and causes of injury are important in helping to reduce their frequency and severity. Injuries are specific to the class of sailing. In elite Olympic-class sailing the incidence of injury is ∼0.2 injuries/athlete/year, with the lumbar and thoracic spine and the knee most commonly injured. Poor hiking technique and inadequate leg strength are thought to predispose the knee to injury. Injuries in novice and recreational sailing are predominantly acute in nature with contusions and abrasions typically occurring as a result of collisions with the boom or other equipment during manoeuvres. The only report of injuries in Paralympic-class sailing found a high rate of ∼100 injuries/1000 days of sailing, likely due to severe sailing conditions. The majority of injuries were chronic in nature, predominantly sprains and strains of the upper extremity. The risk of windsurfing injury ranged from 1.1 to 2.0 injuries/person/year, with the majority of injuries being acute, typically due to impact with equipment. Severe injuries are frequent, with competitive male windsurfers often admitted to hospital for treatment. Chronic lower back injuries are also common in windsurfers and may be related to prolonged lordosis (lumbar extension) of the spine while ‘pumping’ the sail. In professional big-boat sailing, America’s Cup studies have reported an incidence of ∼2.2 injuries/1000 hours of sailing, with one study reporting a higher incidence of injury during fitness training sessions (8.6 injuries/1000 hours of fitness training). The main cause of injury seems to be non-specific overuse, with joint and ligament sprains and tendinopathies being the most common. Grinders and bowmen are at greatest risk of injury, with the repetitive nature of ‘grinding’ a contributing factor. In round-the-world offshore racing, 1.5 injuries/person/round-the-world race (amateur), and 3.2 injuries/person/race (professional) have been reported, with the majority being impact injuries (e.g. contusions, lacerations, fractures and sprains). Helmsmen experience mostly upper-limb overuse injuries as a result of ‘steering’, while mastmen and bowmen are at greater risk of acute injuries. Illnesses and non-injuryrelated complaints account for a large proportion of medical conditions in these events. Sailors of all classes and abilities seem to be at risk of injury, particularly from acute impacts with equipment that might be reduced by wearing protective clothing and more ergonomic boat design. High repetition activities, such as hiking, pumping, grinding and steering, are major causes of overuse injury in experienced sailors. Informed coaching of correct technique and appropriate progression of physical and technical developments are required. Competitive sailors should undergo regular health screening with specific strengthening of high-risk muscle groups, synergists and stabilizers. The scarcity of analytical studies of sailing injuries is a major concern, and there is a need for thorough prospective studies.

NEVILLE V., GLEESON M., FOLLAND J.P.

The relationship between physiological and psychological stress and immune function is widely recognized; however, there is little evidence to confirm a direct link between depressed immune function and incidence of illness in athletes.To examine the relationship between salivary immunoglobulin A (s-IgA) and upper respiratory infections (URI) in a cohort of professional athletes over a prolonged period.Thirty-eight elite America's Cup yacht racing athletes were studied over 50 wk of training. Resting, unstimulated saliva samples were collected weekly (38 h after exercise, consistent time of day, fasted) together with clinically confirmed URI, training load, and perceived fatigue rating.s-IgA was highly variable within (coefficients of variation [CV] = 48%) and between subjects (CV = 71%). No significant correlation was found between absolute s-IgA concentration and the incidence of URI among athletes (r = 0.11). However, a significant (28%, P < 0.005) reduction in s-IgA occurred during the 3 wk before URI episodes and returned to baseline by 2 wk after a URI. When an athlete did not have, or was not recovering from URI, a s-IgA value lower than 40% of their mean healthy s-IgA concentration indicated a one in two chance of contracting an URI within 3 wk.On a group basis, relative s-IgA determined a substantial proportion of the variability in weekly URI incidence. The typical decline in an individual's relative s-IgA over the 3 wk before a URI appears to precede and contribute to URI risk, with the magnitude of the decrease related to the risk of URI, independent of the absolute s-IgA concentration. These findings have important implications for athletes and coaches in identifying periods of high URI risk.

von Elm E., Altman D.G., Egger M., Pocock S.J., Gøtzsche P.C., Vandenbroucke J.P.

Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September, 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles.18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies.A detailed explanation and elaboration document is published separately and is freely available on the websites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE statement will contribute to improving the quality of reporting of observational studies

Feletti F.

Windsurfing now has more than 50 years of history, and continuously for ten editions, it has been included in the Olympic program as a sailing class. The introduction of hydrofoil technology allows for reaching very high speeds, adding spectacularity and attracting the media’s interest. The most popular disciplines are wave, freestyle, slalom, and course racing, but most enthusiasts are free riders who appreciate this sport’s speed, contact with nature, and relative safety. The injury rates range between 0.22 and 5.2/1000 h of windsurfing. Most of the reported injuries are acute (69–78%) and mainly affect the lower limbs (38–59%) and the head/neck region (16–26%), followed by the trunk (8–19%) and upper limbs (6–20%). Most acute injuries are caused by collision with equipment (65–75%), while the most frequent dynamics are uncontrolled falls (37%) resulting in “foot strap injuries” and “catapulting.” Lisfranc injuries, concussions, anterior shoulder dislocation, and wounds represent the most typical windsurfing injuries. Overuse injuries have an incidence of 0.08/year and 0.092/1000 h of windsurfing; most are low back pain, epicondylitis, and exertional compressive neuropathies. In therapeutic choices between conservative and surgical treatment, the expectations of windsurfers, the specific discipline they engage in, and any possible career repercussions must be carefully considered. Educating athletes on the appropriate technical execution and rig choice is integral to rehabilitation. Windsurfing is physically demanding, and adequate endurance and strength training is advisable to prevent acute and overuse injuries.

Beer Y., Yona T., Arama Y., Lindner D., Garrigues G., Feletti F., Blond L., Gilat R.

Objective: To evaluate the prevalence and types of injuries incurred during kiteboarding (1), along with treatment approaches (2). In addition, the time to return to kiteboarding following injury (3) and factors associated with the rate and type of injury were analyzed (4). Setting: Recreational kiteboarding. Design: Retrospective cohort. Participants: Three hundred twelve kiteboarders (280 men, 32 women, mean age 42.91 ± 13) were included in the study. Independent Variables: Age, sex, experience, and the use of protective gear. Main Outcome Measures: Kiteboarding experience, injury location, type, incidence, nonsurgical and surgical treatment modalities, and return-to-kiteboarding data. Results: The number of injuries calculated per 1000 sessions was a mean of 7.82 (4.83-10.81). Patients with less than 2 years of kiteboarding experience were at a greater risk of injury than more experienced kiters (P < 0.001). The knee (24.1%), ankle and foot (18.9%), ribs (12.7%), and shoulder (10.2%) were the body parts most frequently injured. Overall, 14.4% of kiters underwent surgical intervention, with knee surgery being the most common site of operation (41.9%) and the most frequently performed procedure being anterior cruciate ligament reconstruction. Conclusions: The pattern of reported injury was found to be different from that previously reported in the scientific literature among freeriding kiters, with knees, ribs, and shoulders being most frequently involved. Participants with <2 years of experience had a significantly greater risk of injury; therefore, proper technical and physical training is advisable.

Terrien E., Genevey M., Kermarrec G., Saury J.

It is widely accepted in sports psychology that emotions and performance are interrelated. However, the interplay between athletes’ emotions and the associated involvements in the situation, perceptions and technical adaptations has remained largely unexplored in ecological sport settings. Therefore, the purpose of the present study is to use an activity-centered approach to apprehend these links in an ecological setting. We used the theoretical and methodological framework of the course of experience to analyze the activity of two elite Formula Kite riders during speed tests. Our results highlight that during the speed tests, the riders’ pleasant emotional tones were associated with technical adaptations mostly related to global involvements in the situation and global sources of perturbation, while unpleasant emotional tones were associated with more specific involvements in the situation and local sources of perturbation. Furthermore, pleasant and unpleasant emotional tones were associated with different technical adaptations. Altogether, the results of the study emphasize the interest of apprehending the athlete’s performance optimization through a holistic viewpoint taking into consideration both the athletes’ emotions and their modes of technical adaptation to dynamic sport situations “in the doing”.

May A.T., Bailly N., Sellier A., Avinens V., Huneidi M., Meyer M., Troude L., Roche P., Dufour H., Dagain A., Arnoux P., Farah K., Fuentes S.

Purpose: Each summer, many vacationers enjoy the Mediterranean Sea shores. Among the recreational nautical activities, motorboat cruise is a popular choice that leads to a significant number of thoracolumbar spine fractures at our clinic. This phenomenon seems to be underreported, and its injury mechanism remains unclear. Here, we aim to describe the fracture pattern and propose a possible mechanism of injury. Methods: We retrospectively reviewed the clinical, radiological, and contextual parameters of all motorboat-related spinal fracture cases during a 14-year period (2006–2020) in three French neurosurgical level I centers bordering the Mediterranean Sea. Fractures were classified according to the AOSpine thoracolumbar classification system. Results: A total of 79 patients presented 90 fractures altogether. Women presented more commonly than men (61/18). Most of the lesions occurred at the thoracolumbar transition region between T10 and L2 (88.9% of the levels fractured). Compression A type fractures were seen in all cases (100%). Only one case of posterior spinal element injury was observed. The occurrence of neurological deficit was rare (7.6%). The most commonly encountered context was a patient sitting at the boat’s bow, without anticipating the trauma, when the ship’s bow suddenly elevated while crossing another wave, resulting in a “deck-slap” mechanism hitting and propelling the patient in the air. Conclusions: Thoracolumbar compression fractures are a frequent finding in nautical tourism. Passengers seated at the boat’s bow are the typical victims. Some specific biomechanical patterns are involved with the boat’s deck suddenly elevating across the waves. More data with biomechanical studies are necessary to understand the phenomenon. Prevention and safety recommendations should be given before motorboat use to fight against these avoidable fractures.

Crunkhorn M.L., Wolff A., Drew M., Witchalls J., Lalor B., Toohey L.A.

Objectives To investigate the prevalence, incidence rate (IR) and burden of health problems (injuries and illnesses) in Australian Olympic class and State Sailing Pathway Program (SSPP) athletes over 12-months of training and competition. Design Descriptive epidemiological study. Methods Ninety-two Australian Sailing and SSPP athletes were prospectively followed during the 2019–2020 season. Medical attention injuries and illnesses were prospectively recorded, and further sub-categorised according to time loss. The IR and burden were calculated per 365 athlete-days, with differences in IR between sexes compared using negative binomial generated rate ratios. Results Three hundred and forty-nine injuries were reported in 53 athletes (57.6 %), with 14.3 % resulting in time loss. Injury IR was 3.71 (95%CI = 3.33–4.12) injuries per 365 athlete–days, with no difference observed between sex (IRR = 1.64; 95%CI = 0.81–3.34). Shoulder injuries were found to have the greatest burden. Fifty-four illnesses were reported in 27 athletes (29.3 %), with 39.0 % resulting in time loss. Respiratory infection (n = 22, 40.7 %) was the most common illness reported. Illness IR was 0.57 (95%CI = 0.43–0.75) illnesses per 365 athlete days, with females found to have a 3.6 fold increase in illness compared to males (IRR = 3.6; 95%CI = 2.0–6.7). Conclusions The majority of health problems reported in sailing athletes did not result in time loss. There were no differences in the injury IR between sexes, however females had a 3.6-fold increase in reported illness. These results can inform future strategies to reduce key health problems in sailors. Future research investigating whether performance is impacted by the high rate of non-time loss health problems is warranted.

Trease L., Albert E., Singleman G., Brymer E.

“I remember when sex was safe and skydiving was dangerous” read a popular bumper sticker during the HIV crisis. Popular perceptions of extreme sport (ES) often include the descriptor ‘dangerous’. Therefore, why is the popularity of ES increasing exponentially with “dedicated TV channels, internet sites, high-rating competitions, and high-profile sponsors drawing more participants”? More importantly, how should health practitioners respond to the influx of ES athletes with novel injuries, enquiries and attitudes. This paper describes the results of a collaborative auto-ethnographic approach to answering “what is an extreme sports medicine health care provider and what are the components of an effective Extreme Sports Medicine (ESM) training program?” The study was conducted following the first ESM university course offered in Australia with the intention of assessing the learning design and reflecting on the development and practice of ES health practitioners. We explicated three overarching themes common to both the ES health practitioner and for the effective training of healthcare providers in the support of ES endeavors and athletes. These themes were individual, task and environmental factors. The impacts of these findings confirm that ESM courses are vital and should be designed specifically to ensure that practitioners are effectively supported to develop the unique skills necessary for practice in real world extreme sports events.

Feletti F., Mei-Dan O.

Extreme sports are profoundly transforming sports participation, and many of them have been recognized as Olympic disciplines. This chapter aims to discuss the physiological and biomechanical demands on athletes, review the epidemiology of injuries in extreme sports, and highlight some aspects that are common to the therapeutic–rehabilitative approach to these sports. From the physiological perspective, extreme sports may be broadly categorized into two groups, namely: sports involving extreme mental stress and ultra-endurance activities. Sport-specific orthopedic injuries include tenosynovitis, ligament tears, and fractures caused by the distinct athletic gestures involved in these activities. In the treatment and rehabilitation of extreme sports-related injuries, it is essential to consider the over adherence to rehabilitation exhibited by participants and the need for a complete functional restoration before returning to their sport.