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Injury Surveillance in World Cup Skiing and Snowboarding

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Injury Surveillance in World Cup Skiing and Snowboarding Tonje Wåle Flørenes Injury surveillance in World Cup skiing and snowboarding Faculty of Medicine University of Oslo 2010 Den viktigste livsvisdom må vi oppdage med våre egne øyne Fritjof Nansen Table of contents Table of contents ............................................................................... I Acknowledgements............................................................................III List of papers ...................................................................................VI Abbreviations.................................................................................. VII Summary ...................................................................................... VIII Introduction .....................................................................................1 History of skiing ...............................................................................2 Competitive skiing and snowboarding .....................................................3 Competitive alpine skiing ........................................................................ 3 Competitive freestyle skiing ..................................................................... 3 Competitive snowboarding ....................................................................... 4 Competitive ski jumping.......................................................................... 5 Competitive cross-country skiing................................................................ 5 Competitive Nordic combined ................................................................... 5 The extent of skiing injuries ................................................................6 How to deal with sport injuries? ...........................................................7 Injury causation .................................................................................... 8 Risk factors ........................................................................................ 10 Injury surveillance .......................................................................... 10 Definition of injury ............................................................................... 12 Key epidemiological variables .................................................................. 14 Injury incidence in skiing and snowboarding ........................................... 16 Recreational skiing and snowboarding ........................................................ 16 Competitive skiing and snowboarding......................................................... 23 Injury location and type in skiing and snowboarding ................................. 27 Recreational skiing and snowboarding ........................................................ 30 Competitive skiing and snowboarding......................................................... 33 Injury severity in skiing and snowboarding ............................................. 35 Recreational skiing and snowboarding ........................................................ 35 Competitive skiing and snowboarding......................................................... 37 I Aims of the thesis ............................................................................ 39 Methods......................................................................................... 40 Study population and injury definition .................................................. 40 Paper I ........................................................................................ 40 Study design and participants .................................................................. 40 Data analyses ...................................................................................... 41 Papers II-IV................................................................................... 41 Participants ........................................................................................ 41 Statistics ..................................................................................... 42 Ethics ......................................................................................... 43 Results and discussion ....................................................................... 44 Comparison of three different methods for injury surveillance in World Cup skiing and snowboarding (Paper I) ............................................................... 44 Sports Injury Surveillance - Retrospective vs. prospective recording.................... 45 Injury definition................................................................................... 46 Athlete and coach interviews................................................................... 47 The injury risk in World Cup skiing and snowboarding (Paper II) ................... 47 The magnitude of the problem ................................................................. 47 Injury rates over three seasons (Papers II-IV) ................................................ 51 Relative injury rates in World Cup alpine and freestyle skiing (Paper III & IV)... 53 Alpine skiing (Paper III) .......................................................................... 53 Freestyle skiing (Paper IV) ...................................................................... 53 Injury patterns .............................................................................. 54 Knee injuries....................................................................................... 56 Are there any differences in injury risk between men and women? (Papers II-IV)58 Limitations ..................................................................................... 60 Conclusions .................................................................................... 61 References ..................................................................................... 62 Appendix 1-3 .................................................................................. 76 Papers I-IV......................................................................................... II Acknowledgements I feel truly privileged for the opportunity to work with this project. I have had some fantastic years and would like to express my sincere gratitude to some outstanding and very special people: Roald Bahr, MD, PhD, co-founder of the Oslo Sports Trauma Research Center, professor at the Norwegian School of Sport Sciences and my main supervisor. Your outstanding knowledge, interest in the sport medicine field and your supportive attitude have been very helpful. I am privileged to be a part of this research group and shall always appreciate your belief in young colleagues including myself. Thank you for your thorough, effective and structured feedback on manuscript and presentations. Roald, you have been the best supervisor I could possibly have had in this PhD process! Lars Nordsletten, MD, PhD, professor at the Orthopaedic Centre, Oslo University Hospital- Ullevål and Oslo Sports Trauma Research Center and co-advisor. Your always positive and cheerful attitude is much appreciated. Your true interest in winter sports (especially cross-country skiing) has been of great value and I have enjoyed the times we have discussed challenges and aspects within the field of skiing and snowboarding medicine. Lars Engebretsen, MD, PhD, co-founder of the Oslo Sports Trauma Research Center, professor at the Orthopaedic Centre, Oslo University Hospital-Ullevål and chief physician at the Olympic Training Center. Your unlimited working capacity and knowledge are amazing. I’m especially grateful that you gave me the opportunity to become a part of the clinical world of sports medicine. It is also thanks to you and your entry into the football-field to assist an injured player some years ago that I got to realize my dream of working in the sports medicine field. Stig Heir, MD (soon to be PhD), co-author of all papers and fellow travel companion to different skiing and snowboarding meetings throughout the world. I’ve really enjoyed your friendship and good discussions. Ingar Holme, PhD, professor in statistics at the Department of Sports Medicine, Norwegian School of Sport Sciences. Thank you for your open door and your helping out with statistical advice. Tone Bere, PT and PhD student at the Oslo Sports Trauma Research Center, co-author of paper III. Thank you for good help and support with data collection and analysis. III John Bjørneboe, medical student and PhD fellow. Thank you for the data analysis from Tippeligaen and for helping out with the data collection. Tor Pedersen, MD. Thank you for valuable help with constructing a database. I truly appreciate all the wonderful colleagues and friends at the Oslo Sports Trauma Research Center and Department of Sports Medicine for a young, inspiring and fun group to be a part of. Thanks to Grethe, for your friendship, important comments about life and all the “fika-pauser”, Tron for always smiling and helping out with computer challenges, Tone Ø for your friendly help and conversations during these years and Thor Einar for your great and inspiring cooperation and for letting me be a part of your research when I worked with my project during medical school. Arne Ekeland, professor. Your enthusiasm and life experience in skiing has been to great inspiration. Thank you for willingly sharing of your great knowledge and experience. I shall never forget some special people I have had the pleasure to get to know in the Sport Medicine field. Vibeke Wollen, PT and colleague while working with the Norwegian Women’s Soccer Team.
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