The effectiveness and implementation of the BokSmart Safe Six Injury prevention programme

INTRODUCTION: Injury prevention programmes in rugby union are important to reduce the sport’s injury burden. The BokSmart Safe Six exercise-based injury prevention programme (“Safe Six”) was designed for this purpose. The programme incorporates six targeted exercises as a warm-up for rugby players. The effectiveness of the BokSmart Safe Six programme was assessed using the “Sequence of Prevention” Model. METHODS: The first study was a prospective cohort study using injury surveillance, of players at the South African Rugby (SA Rugby) Youth week tournaments. The study was conducted over six years to determine the injury incidence density (IID) youth players and also factors associated with the IID. The second study was a systematic review with the purpose of determining the effectiveness of exercise-based injury prevention interventions to reduce injury rates in collision sports. The next study was conducted over three years of SA Rugby Youth weeks and assessed the awareness of coaches and players of the BokSmart Safe Six following a targeted-marketing approach. This was followed by a study in which the BokSmart Safe Six programme was implemented in a cohort of apparently healthy non-rugby playing adults. The aim of this study was to determine the efficacy of the programme on injury risk profiles (Functional Movement Screening and Musculoskeletal Screening Assessments). The final study was a cluster-randomised controlled trial (cRCT) over eight weeks, using six schools (n = 210 players) in the Western Cape to determine the effectiveness of the BokSmart Safe Six on injury risk profiles and IID. RESULTS AND CONCLUSIONS: SA youth rugby cohort have a similar IID to other youth rugby cohorts (and in some instances lower). The systematic review identified only one highlevel study (out of three) that was effective for injury prevention. The players’ awareness of the BokSmart Safe Six was associated with the awareness of their specific coaches’ awareness. The awareness increased during the targeted marketing approach. The BokSmart Safe Six was associated with minimal significant improvements of the injury risk profiles in both the healthy adults and in the cRCT intervention group youth rugby players

Key performance indicators and predictors in Varsity Cup rugby

Rugby union is a popular sport worldwide, and due to the professional nature of the sport the demands on players continues to increase, resulting in acute and chronic fatigue. The aims of the study were to investigate the tools used to monitor and predict changes in training status and determine the effectiveness of these to: (i) measure the subjective nature of coaches and their selection relating to the players’ performance, and (ii) to use performance indicators to correlate to team performance. The University of Cape Town Rugby Varsity Cup Team (First XV squad) were monitored from their pre-pre-season until the end of their competitive season. Players completed a testing battery (anthropometry, strength, muscular endurance, speed and aerobic fitness) during the season, along with Rating of Perceived Exertion and body mass was recorded every practice. Players also completed the HIMs test (measure of heart rate recovery) weekly. Coaches rated players every practice on three variables and the matches were recorded and video analysis performed to determine key performance variables. Most of the players improved in their testing battery between pre-pre-season and pre-season. Average session load varied across the phases of the season and was highest in the pre-preseason. Change in load however, was not reflected by changes in heart rate recovery which remained relatively stable across the season. The players’ body mass varied throughout the tournament, with certain players having a larger coefficient of variation compared to others. There was no relationship between performance in the testing battery and selection for matches. The coaches all had different ratings for the players, with no correlation between players selected and those not selected. There was a correlation between the subjective rating of players in the week leading up to the match and the match ratings of Coach 3 (head coach). The Varsity Cup rugby union players followed similar trends described in previous literature in physiological testing batteries, training loads and player management. The novel aspect of this study was the collection of data from the coaches involved. This qualitative data provides insight into the coaches’ selection process or lack thereof within a team environment. The data also illustrates the differences between the coaches’ interpretation of the players’ “performance”. The Varsity Cup is a relatively young tournament and should be further investigated to properly understand the differences between it and professional and amateur rugby union

Predictors of multiple injuries in individual distance runners: A retrospective study of 75,401 entrants in 4 annual races- safer xxx

There are limited data on factors that predict an increased risk of multiple injuries among distance runners. The objective of this study was to determine risk factors that are predictive of individual runners with a high annual multiple injury risk (MIR). A retrospective, cross-sectional study at 4 annual (2012–2015) Two Oceans 21.1 km and 56.0 km races in South Africa with 75,401 consenting race entrants. Running-related injury data were collected retrospectively through an online pre-race medical screening questionnaire. The average number of injuries for each runner every year was calculated by taking a runner's race entry history and injury history into account and categorizing entrants into 4 MIR categories (high, intermediate, low, and very low (reference))

Pre-race screening and stratification predicts adverse events—A 4-year study in 29585 ultra-marathon entrants, SAFER X

Pre-race screening and risk stratification in recreational endurance runners may predict adverse events (AEs) during a race. Aim: To determine if pre-race screening and risk stratification predict AEs during a race. Methods: A total of 29 585 participants (Male 71.1%, average age = 42.1 years; Female 28.9%, average age = 40.2 years) at the Two Oceans ultra-marathon races (56 km) completed a pre-race medical screening questionnaire and were risk stratified into four pre-specified groups [very high risk (VHR; existing cardiovascular disease–CVD:3.2%), high risk (HR; risk factors for CVD:10.5%), intermediate risk (IR; existing other chronic disease, medication use or injury:53.3%), and low risk (LR:33.0%)]. Race starters, finishers, and medical encounters (ME) were recorded. Did-not-start (DNS) rate (per 1000 entrants that did-not-start), did-not-finish (DNF) rate (per 1000 starters that did-not-finish), AE rate [per 1000 starters that either DNF or had an ME], and ME rate (per 1000 starters with an ME) were compared across risk categories. Results: Adverse events were significantly higher (per 1000 starters; 95%CI) in the VHR (68.9; 52.4-89.9:P =.0407) compared with the LR (51.3; 46.5-56.7)

Medical encounters among 94,033 race starters during a 16.1-km running event over 3 years in the Netherlands: SAFER XXVI

BACKGROUND : There are limited data on the medical encounters (MEs) occurring during mass community-based running events of shorter distances (10-21.1 km). The aim of this study was to determine the incidence and nature of MEs during the largest mass participation running event in the Netherlands. HYPOTHESIS : We hypothesize that the incidence and nature of MEs will be similar to other running events. STUDY DESIGN : Descriptive epidemiological study over 3 years of a 16.1-km (10-mile) running event. LEVEL OF EVIDENCE : Level 4. METHODS : We investigated a total of 94,033 race starters at the 2017-2019 Dam tot Damloop (16.1 km), a point-to-point road race from Amsterdam to Zaandam, the Netherlands. All MEs were recorded by race medical staff on race day each year. MEs were retrospectively coded by severity, organ system, and final specific diagnosis (2019 consensus statement definition on mass community-based events). Incidence (I) per 1000 starters (95% CIs) were calculated for all MEs and serious/life-threatening MEs. RESULTS : The overall incidence (per 1000 starters) of all MEs was 2.75 (95% CI, 2.44-3.11), the overall incidence of serious/life-threatening MEs was 1.20 (95% CI, 1.00-1.45; 44% of MEs). Heat illnesses accounted for most MEs: hypothermia I = 0.54 (95% CI, 0.41-0.71) and hyperthermia I = 0.46 (95% CI, 0.34-0.62). Central nervous system MEs were also common (dizziness/nausea, I = 0.79; 95% CI 0.63-0.99), followed by the cardiovascular system MEs (exercise-associated postural hypotension, I = 0.36; 95% CI, 0.26-0.51). CONCLUSION : The overall incidence of MEs was low compared with longer-distance races (21.1-90 km), but the incidence and relative frequency of serious/life-threatening MEs (44% of all MEs) was much higher. Heat illness (hypothermia and exertional heat stroke) accounted for most serious/life-threatening MEs. CLINICAL RELEVANCE : There is a need to implement prevention strategies and interventions by specialized medical practitioners in this and similar events.IOC Research Center (South Africa).https://journals.sagepub.com/home/SPHhj2022Sports Medicin

Pre-race self-reported medical conditions and allergies in 133 641 Comrades ultramarathon (90km) runners - SAFER XXIII

Objectives: To determine the prevalence of self-reported pre-race chronic medical conditions and allergies in ultramarathon race entrants and to explore if these are associated with an Increased risk of race-day medical encounters (MEs). Methods: Data from two voluntary open-ended pre-race medical screening questions (Q1 – history of allergies; Q2 - history of chronic medical conditions/prescription medication use) were collected in 133 641 Comrades Marathon race entrants (2014-2019). Race-day ME data collected prospectively over 6 years are reported as incidence (per 1000 starters) and incidence ratios (IR: 95%CI’s)

Predictors of multiple injuries in individual distance runners : a retrospective study of 75,401 entrants in 4 annual races-SAFER XX

BACKGROUND: There are limited data on factors that predict an increased risk of multiple injuries among distance runners. The objective of this study was to determine risk factors that are predictive of individual runners with a high annual multiple injury risk (MIR). METHODS: A retrospective, cross-sectional study at 4 annual (2012 2015) Two Oceans 21.1 km and 56.0 km races in South Africa with 75,401 consenting race entrants. Running-related injury data were collected retrospectively through an online pre-race medical screening questionnaire. The average number of injuries for each runner every year was calculated by taking a runner’s race entry history and injury history into account and categorizing entrants into 4 MIR categories (high, intermediate, low, and very low (reference)). Multiple logistic regression modeling (odds ratios) was used to determine whether the following factors were predictive of a high MIR (average > 1 injury/year): demographics, training and racing, chronic-disease history (composite chronic disease score (CCDS)), and history of allergies. RESULTS: Of all entrants, 9.2% reported at least 1 injury, and 0.4% of entrants were in the high MIR category; the incidence rate was 2.5 injuries per 10 runner-years (95% confidence interval (95%CI): 2.4 2.7). Significant factors predictive of runners in the high MIR category were: running for > 20 years: OR = 2.0 (95%CI: 1.3 3.1; p = 0.0010); a higher CCDS: OR = 2.2 (95%CI: 2.0 2.4; p < 0.0001); and a history of allergies: OR = 2.8 (95%CI: 2.0 3.8; p 20 years and those with multiple chronic diseases or a history of allergies were at higher risk of multiple running-related injuries. This high-risk group can be targeted for further study and possible injury-prevention interventions.https://www.journals.elsevier.com/journal-of-sport-and-health-science/Sports Medicin

Exercise-induced laryngeal obstruction (EILO) in athletes: a narrative review by a subgroup of the IOC Consensus on 'acute respiratory illness in the athlete'

Exercise-induced laryngeal obstruction (EILO) is caused by paradoxical inspiratory adduction of laryngeal structures during exercise. EILO is an important cause of upper airway dysfunction in young individuals and athletes, can impair exercise performance and mimic lower airway dysfunction, such as asthma and/or exercise-induced bronchoconstriction. Over the past two decades, there has been considerable progress in the recognition and assessment of EILO in sports medicine. EILO is a highly prevalent cause of unexplained dyspnoea and wheeze in athletes. The preferred diagnostic approach is continuous visualisation of the larynx (via laryngoscopy) during high-intensity exercise. Recent data suggest that EILO consists of different subtypes, possibly caused via different mechanisms. Several therapeutic interventions for EILO are now in widespread use, but to date, no randomised clinical trials have been performed to assess their efficacy or inform robust management strategies. The aim of this review is to provide a state-of-the-art overview of EILO and guidance for clinicians evaluating and treating suspected cases of EILO in athletes. Specifically, this review examines the pathophysiology of EILO, outlines a diagnostic approach and presents current therapeutic algorithms. The key unmet needs and future priorities for research in this area are also covered.publishedVersio

Risk factors for not finishing an ultramarathon : 4-year study in 23,996 race starters, SAFER XXI

BACKGROUND: Limited data support prerace medical screening to identify risk factors for not finishing an endurance running race. The aim of the study was to determine risk factors associated with not finishing an ultramarathon. METHODS: A prospective, cross-sectional study of Two Oceans ultramarathon (56 km) race starters who completed a prerace medical screening questionnaire. Race day environmental conditions were recorded on race day. Univariate analyses of risk factors associated with the did-not-finish (DNF) included race day factors and prerace medical screening history. RESULTS: Risk factors for DNF amongst 23,996 starters during the 56 km race included older age and females (P<0.0001). After adjusting for age and sex, the following were significant univariate risk factors: fewer years of running (P<0.0001), less previous race experience (P<0.0001), less training/racing per week (P=0.0002), lower average weekly training distance (P=0.0016), slower race vs. training speed (P<0.0001), lack of allergies (P=0.0100) and average wet-bulb globe temperature (P<0.0001). CONCLUSIONS: Females, older age, training-related factors (less training/racing, average weekly training distance, race vs. training speed) and average wet-bulb temperature, were risk factors for not finishing an ultramarathon. The results may not only assist runners and coaches in race preparation, but also have clinical implications for the medical planning prior to races.IOC Research Centre (South Africa) and South African Medical Research Council (partial funding).https://www.minervamedica.it/en/journals/sports-med-physical-fitnesshj2023Sports Medicin

Diagnosis and management of nasal obstruction in the athlete : a narrative review by subgroup B of the IOC Consensus Group on “Acute Respiratory Illness in the Athlete”

Protection of the health of the athlete is required for high level sporting performance. Acute respiratory illness is the leading cause of illness and can compromise training and competition in athletes. To date the focus on respiratory health in athletes has largely been on acute upper respiratory infections and asthma/exercise induced bronchoconstriction (EIB), while nasal conditions have received less attention. The nose has several important physiological functions for the athlete. Nasal conditions causing obstruction to airflow can compromise respiratory health in the athlete, negatively affect quality of life and sleep, cause mouth breathing and ultimately leading to inadequate recovery and reduced exercise performance. Nasal obstruction can be broadly classified as structural (static or dynamic) or mucosal. Mucosal inflammation in the nose (rhinitis) is the most frequent cause of nasal obstruction and is reported to be higher in athletes (21-74%) than in the general population (20-25%). This narrative review provides the sport and exercise medicine physician with a clinical approach to the diagnosis and management of common nasal conditions that can cause nasal obstruction, ultimately leading to improved athlete health and better sports performance.IOC Research Center (South Africa)http://www.minervamedica.it/it/riviste/sports-med-physical-fitness/index.php2022-06-22hj2022Sports Medicin