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Background Although injuries to the head represent a small proportion of all sport injuries, they are of great concern due to their potential long-term consequences, which are even suspected in mild traumatic brain injuries. Objective The aim of this review was to compare the incidence of concussions and other head injuries in elite level football, rugby, ice hockey and American Football. Methods Four electronic databases (CINAHL, PsycINFO, Web of Science, PubMed) were searched. Prospective cohort studies on the incidence of concussion in elite athletes aged 17 years or older that were published in an English-language peer-reviewed journal since 2000 were included. Two authors independently evaluated study eligibility and quality. The extracted data on concussions were pooled in a meta-analysis using an inverse-variance fixed-effects model. The extracted data on head injuries were reported in a narrative and tabular summary. Results The search yielded 7673 results of which 70 articles were included in the qualitative and 47 in the quantitative analysis. In our meta-analysis, we found the highest concussion incidences in rugby match play (3.89 and 3.00 concussions per 1000 h and athletic exposures (AEs), respectively), and the lowest in men’s football training (0.01 and 0.08 per 1000 h and AEs, respectively). Overall, concussions and all head injuries were rare in training when compared to match play. Female players had an increased concussion risk in football and ice hockey when compared to male players. Conclusion Future research should focus on concussion in women’s contact sports, as there is little evidence available in this area. Methodological deficits are frequent in the current literature, especially regarding sample size and study power, and should be avoided.

In the last decade, injury prevention has received a lot of attention in sports medicine, and recently international sports-governing bodies, such as the International Olympic Committee, declared the protection of the athletes’ health as one of their major objectives. In 1994, the Fédération Internationale de Football Association (FIFA) established its Medical Assessment and Research Centre (F-MARC) with the aim ‘to prevent football injuries and to promote football as a health-enhancing leisure activity, improving social behaviour’. Since then, FIFA has developed and evaluated its injury-prevention programmes ‘The 11’ and ‘FIFA 11+’ have demonstrated in several scientific studies how simple exercise-based programmes can decrease the incidence of injuries in amateur football players. This paper summarises 18 years of scientific and on-field work in injury prevention by an international sports federation (FIFA), from formulating the aim to make its sport safer to the worldwide dissemination of its injury-prevention programme in amateur football.

BackgroundScientific studies on the prevalence of mental health problems in elite athletes are rare, and most have had considerable methodological limitations, such as low response rate and heterogeneous samples.AimsTo evaluate the prevalence of depression and anxiety in top-level football players in comparison to the general population, and to analyse potential risk factors.MethodsPlayers of all first league (FL) and of four U-21 football teams in Switzerland were asked to answer a questionnaire on player's characteristics, the Centre of Epidemiologic Studies Depression Scale (CES-D) and the Generalized Anxiety Disorder (GAD-7) scale.ResultsAll 10 women's FL teams, 9 of 10 men's FL teams and 4 male U-21 teams (n=471 football players) took part in the study. The CES-D score indicated a mild to moderate depression in 33 (7.6%) players and a major depression in 13 (3.0%) players. The GAD-7 score indicated an at least moderate anxiety disorder in 6 (1.4%) players. Compared to the general population, the prevalence of depression was similar and the prevalence of anxiety disorders was significantly (χ2=16.7; p<0.001) lower in football players. Significant differences were observed with regard to player characteristics, such as age, gender, player position, level of play and current injury.ConclusionsSwiss FL football players had the same prevalence of depression as the general population, while male U-21 players had a higher prevalence of depression. It is important to raise awareness and knowledge of athletes’ mental health problems in coaches and team physicians, and to provide adequate treatment to athletes.

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.

Background: 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- or setting-specific consensus statements on sports injury (and, eventually, illnesses) epidemiology to date. Objective: 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. Study Design: Consensus statement of the International Olympic Committee (IOC). Methods: 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. Results: 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). Conclusion: The IOC encourages ongoing in- and out-of-competition surveillance programs and studies to describe injury and illness trends and patterns, understand their causes, and develop measures to protect the health of the athlete. The implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.

Background The incidence and characteristics of football injuries during matches in top-level international tournaments are well documented, but training injuries and illnesses during this period have rarely been studied. Aim To analyse the incidence and characteristics of injuries and illnesses incurred during the 2010 Fédération Internationale de Football Association (FIFA) World Cup. Methods The chief physicians of the 32 finalist teams reported daily all newly incurred injuries and illnesses of their players on a standardised medical report form. Results Out of 229 injuries reported, 82 match and 58 training injuries were expected to result in time loss, equivalent to an incidence of 40.1 match and 4.4 training injuries per 1000 h. Contact with another player was the most frequent cause of match (65%) and of training (40%) injuries. The most frequent diagnoses were thigh strain and ankle sprain. 99 illnesses of 89 (12%) players were reported. Illnesses were mainly infections of the respiratory or the digestive system. Most illnesses did not result in absence from training or match. The incidence of time-loss illnesses was 3.0 per 1000 player days. Conclusion The incidence of match injuries during the 2010 FIFA World Cup was significantly lower than in the three proceeding World Cups. This might be a result of more regard to injury prevention, less foul play and stricter refereeing. Tackling skills and fair play need to be improved to prevent contact injuries in training and matches. Prevention of illness should focus on reducing the risk of infections by considering the common modes of transmission and environmental conditions.

Background The promotion of sport and physical activity (PA) for children is widely recommended to support a healthy lifestyle, but being engaged in sport bears the risk of sustaining injuries. Injuries, in turn, can lead to a reduction in current and future involvement in PA and, therefore, may negatively affect future health as well as quality of life. Thus, sports injury prevention is of particular importance in youth. Objective The aim of this systematic review was to quantify the effectiveness of exercise-based injury prevention programs in child and adolescent sport in general, and with respect to different characteristics of the target group, injury prevention program, and outcome variables. Data Sources An Internet-based literature search was conducted in six databases (CINAHL, Cochrane, EMBASE, ISI Web of Science, PubMed, SPORTDiscus) using the following search terms with Boolean conjunction: (sport injur* OR athletic injur* OR sport accident*) AND (prevent* OR prophylaxis OR avoidance) AND (child* OR adolescent OR youth). Study Selection Randomized controlled trials and controlled intervention studies in organized sport, published in English in a peer-reviewed journal, analyzing the effects of an exercise-based injury prevention program in athletes younger than 19 years of age. Data Extraction Two reviewers evaluated eligibility and methodological quality. Main outcome extracted was the rate ratio (RR). Statistical analyses were conducted using the inverse-variance random effects model. Results Twenty-one trials, conducted on a total of 27,561 athletes (median age 16.7 years [range 10.7–17.8]), were included. The overall RR was 0.54 (95 % CI 0.45–0.67) [ p  < 0.001]. Girls profited more from injury prevention than boys ( p  = 0.05). Both prevention programs with a focus on specific injuries (RR 0.48 [95 % CI 0.37–0.63]) and those aiming at all injuries (RR 0.62 [95 % CI 0.48–0.81]) showed significant reduction effects. Pre-season and in-season interventions were similarly beneficial ( p  = 0.93). Studies on programs that include jumping/plyometric exercises showed a significant better ( p  = 0.002) injury preventive effect (RR 0.45 [95 % CI 0.35–0.57], Z  = 6.35, p  < 0.001) than studies without such exercises (RR 0.74 [95 % CI 0.61–0.90], Z  = 3.03, p  = 0.002). Conclusions The results provide good evidence and clearly demonstrate beneficial effects of exercise-based injury prevention programs in youth sports as they can result in statistically significant and practically relevant injury reduction. In particular, multimodal programs including jumping/plyometric exercises can be recommended. However, there is a considerable lack of data for children (under 14 years of age) and for individual sports in general. Future research should include these groups and focus on the effect of specific exercises and compliance.

ObjectiveTo analyse differences between athletic disciplines in the frequency and characteristics of injuries during international athletics championships.MethodsStudy design, injury definition and data collection procedures were similar during the 14 international championships (2007–2018). National medical teams and local organising committee physicians reported all newly incurred injuries daily on a standardised injury report form. Results were presented as number of injuries and number of injuries per 1000 registered athletes, separately for male and female athletes, and for each discipline.ResultsFrom a total of 8925 male and 7614 female registered athletes, 928 injuries were reported in male and 597 in female athletes. The discipline accounting for the highest proportion of injuries was sprints, for both men (24%) and women (26%). The number of injuries per 1000 registered athletes varied between disciplines for men and women: highest in combined events for male athletes (235 (95% CI 189 to 281)) and female athletes (212 (95% CI 166 to 257)), and lowest for male throwers (47 (95% CI 35 to 59)) and female throwers (32 (95% CI 21 to 43)) and for female race walkers (42 (95% CI 19 to 66)). Injury characteristics varied significantly between disciplines for location, type, cause and severity in male and female athletes. Thigh muscle injuries were the main diagnoses in the disciplines sprints, hurdles, jumps, combined events and race walking, lower leg muscle injuries in marathon running, lower leg skin injury in middle and long distance running, and trunk muscle and lower leg muscle injuries in throws.ConclusionsInjury characteristics differed substantially between disciplines during international athletics championships. Strategies for medical service provision (eg, staff, facilities) during athletics championships should be discipline specific and be prepared for targeting the main injuries in each discipline.

Background FIFA has surveyed match injuries in its tournaments since 1998. Aim To analyse the incidence and characteristics of match injuries incurred during the 2014 FIFA World Cup in comparison to previous FIFA World Cups. Methods The chief physicians of the participating teams reported all newly incurred injuries of their players after the match on a standardised report form. 124 (97%) forms were returned. Results A total of 104 injuries were reported, equivalent to an incidence of 1.68 injuries per match (95% CI 1.36 to 2.00). 64 (63.4%) injuries were caused by contact with another player. Thigh (26; 25%) and head (19; 18%) were the most frequently injured body parts. The most frequent diagnosis was thigh strain (n=18). Five concussions and three fractures to the head were reported. While most thigh strains (15/17; 88.2%) occurred without contact, almost all head injuries (18/19; 94.7%) were caused by contact. 0.97 injuries per match (95% CI 0.72 to 1.22) were expected to result in absence from training or match. Eight injuries were classified as severe. The incidence of match injuries in the 2014 FIFA World Cup was significantly lower than the average of the four preceding FIFA World Cups, both for all injuries (2.34; 95% CI 2.15 to 2.53) and time-loss injuries (1.51; 95% CI 1.37 to 1.65). Conclusions The overall incidence of injury during the FIFA World Cups decreased from 2002 to 2014 by 37%. A detailed analysis of the injury mechanism is recommended to further improve prevention strategies.

Background Mental health problems cover a wide spectrum. Depression and anxiety disorders are the most frequent mental health problem in the general population and in elite athletes. The aim of the present study was to assess the prevalence of symptoms of depression, generalised anxiety disorder and eating disorders in professional dancers, to compare the results between genders and to the general population and to analyse potential determinants. Methods During a pre-season health screening, professional dancers of six German companies answered a comprehensive questionnaire on personal and dancer-specific characteristics, medical history and the Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder Questionnaire (GAD-7) and Eating-Disorder-Examination-Questionnaire (EDE-QS). Results A total of 82 (55.8%) female and 65 (44.2%) male dancers answered the questionnaire. One in five (20.8%) dancers had at least moderate symptoms of either depression, generalised anxiety disorder or eating disorders. The prevalence of at least moderate symptoms of depression was 11.1% in female and 6.4% in male dancers, of generalised anxiety disorder 16.0% in female and 6.4% in male dancers and of eating disorders 14.8% in female and 6.1% in male dancers. Compared to the general population of the same gender and similar age, the prevalence of at least moderate symptoms of generalised anxiety disorder was significantly higher in both genders. About one in four dancers (26.9%) reported a subjective need for support from a psychotherapist at the time of the screening. The PHQ-9, GAD-7 and EDE-QS sum scores were not related to the size or type of the companies, the age or rank of the dancers, but the PHQ-9 and GAD-7 sum score were significantly related to severity of musculoskeletal pain in the past seven days and to chronic or recurrent symptoms of low mood and generalised anxiety. Conclusion The prevalence of symptoms of depression, generalised anxiety and eating disorders was high in professional dancers. Routine screening and low-threshold interventions to improve mental health of professional dancers are recommended. Key points One in five (20.8%) dancers had at least moderate symptoms of either depression, generalised anxiety disorder or eating disorders, and more than a quarter of the dancers (26.9%) wanted or needed support from a psychotherapist/psychologist for personal or mental health problems at the time of the screening. The prevalence of at least moderate symptoms of depression was 11.1% in female and 6.4% in male dancers, of generalised anxiety disorder 16.0% in female and 6.4% in male dancers and of eating disorders 14.8% in female and 6.1% in male dancers. Mental health problems should be a part of routine health screenings of professional dancers, and low-threshold access to adequate treatment should be provided to dancers identified in screenings.