') with particular
In: Reilly T, Wi! toutJedge, 2003:
Affiliation 1 Department of Physical Medicine and Rehabilitation, General Hospital Sveti Duh, Zagreb, Croatia 1Department of Movement Sciences, Faculty of Health Sciences, University of Maastricht, The Netherlands 3 University of British Columbia Faculty of Medicine, Vancouver, BC, Emergency Medicine and Sport Medicine, Victoria, B. C, Canada Sestre Milosrdnice University Hospital, ENT Department, Zagreb, Croatia Department ofOrthopaedic Surgery, School ofMedicine University of Zagreb, Zagreb, Croatia
Correspondence Sanda Dubravcic-Simunjak· Department of Physical Medicine and Rehabilitation· General Hospital "Sveti Duh" . Sveti Duh 64· 10000 Zagreb· Croatia· Phone: work: +38513 7122 85 . Phone: home: +38 5148433 73· Fax: +38 513 745527· E-mail: sanda-dubravcic.simunjak@zg,htnet.hr
Accepted after revision: May 30, 2005
Bibliography Int JSports Med 2006; 27: 493 -499 © Georg Thieme Verlag KG· Stuttgart· New York· D0I1O.10551s-2005-865816· Published online September 15,2005, ISSN 0172-4622
~." Introduction Materials and Methods . Table 1 Absc The International Skating Union (lSU) governs the winter sports Before the World Synchronized Skating Championship 2004 the sync division of figure skating, speed skating, short track speed skat questionnaire consisting of 22 questions was mailed to all 23 stud ing, and synchronized skating. Synchronized Skating is the new participating teams, including 528 skaters. The skaters were re est discipline within the ISO, In 2000 the first World Synchron quested to return the form upon arrival. As not all teams com ized skating Championship was held in Minneapolis, USA with pleted the questionnaire before the Event, the questionnaire 21 teams from 17 nations, and since then has become an annual was redistributed to those teams during Championship held in event [7]. Zagreb from 151 until 4th April 2004. After filling out the question naire, often with coaches orland team doctor's assistance, which In synchronized skating up to 20 skaters, mostly females, skate required 10 - 25 minutes, all participants were requested to re Trunk together in unison, performing different formations on the ice. turn it before the closure ofthe Championship to the Internation The main characteristic of the sport is synchronized work by al Skating Union (ISU) Medical AdvisOr present at the Champion Lower extreml skater's legs, body, arms, and head. Synchronization refers to ship. the importance of unison, the accuracy of the formations, and the precision of the team [6]. The questionnaires inquired about the site and types of acute and overuse injuries that occurred during their synchronized skating Junior level skaters are 12 to 19 years old, while Senior skaters career. It also inquired about the age of the skater, when the in are 14 years and over, with no maximum age limit. Junior and juries occurred, the injury treatment (conservative vs. surgery), 23 teams, 4 Senior teams have Short programs with required elements and and the time period the skaters were required to be off the ice. participatin~ Free skating programs while Juveniles, Novices, and Veterans In addition questions were asked about their current age, the 8 hours (2 have only the Free skating program performed to music chosen age when they started to skate, as well as the age when they On average, 1 by the team, lasting for a specified period of time. The short pro started to skate in synchronized skating. Major parts of the ques· ing while otl gram for synchronized skating consists of different required ele tionnaires inquired about the incidence of injuries with refer ing. All of th! ments: circle, line, block, wheel, intersection, spin, and moves in ence to on-Ioff-ice training, practicing team (i.e. block, line, inter average) per the field, while the order of elements in the program is optional. section, etc.) or individual elements (i.e. jumps, spins, etc.) We The free skating program must be well balanced between all also inquired about possible overuse syndromes that occurred Among 5141 team elements, and the movements in isolation must be linked during their previous figure skating and their synchronized skat ed from acu together harmoniously by a variety of transitions and executed ing career, as well as the age of menarche for female skaters. while amon: with a minimum of two footed skating. Special credit is given to ries while S! those teams whose performance includes not only conventional After receiving the questionnaires the data were fed into a com ries is ShOWI elements performed in clean, fast, and sure synchronization with puter using Excel software. Descriptive statistics was used for juries and t precise transitions, but also contains innovative and creative ele analysis of the data. gions is pre5 ments [6,7]. had suffere( nized skatin To make the sport more attractive and competitive more and Results viding a tote more difficult elements are added into the programs. In the last ries in male four years spins, jumps, step sequences, movements in isolation, The 23 participating teams from 18 countries and 5 continents (57.1%) of t moves in the field and twizzles, turns of one half or entire revo (Europe, America, Asia, Africa, and Australia) correctly and com· synchronize lution executed on one or two feet, have been added into pletely filled in the questionnaires. With a 100% response a total synchronized skating programs. Coaches and team managers of 514 ladies and 14 men senior skaters completed the question are trying to maximize the difficulty of these elements in the naires. . pursuit of success and podium finishes at leading international Table 2 Abs competitions and world championships [6]. The median age was 19.4 yrs for female skaters (aged between 15 weT and 28) and 22.2 yrs for male skaters (aged between 18 and 32). The rapidly increasing demands on performance of the Both female and male skaters started to skate when they were synchronized skaters may lead to specific training and injury is between 3 and 14 yrs. Three hundred and ninty-four skaters sues. Since epidemiological studies of injuries in elite synchro (75 %) who figure skated before joining the synchronized skating nized skaters are lacking, the aim ofthis study was to collect data team started to skate at an age of 3 - 7 yrs. Once they joined the about physical and training characteristics specific to the sport team, they did not practice other skating disciplines. One hun and to assess the occurrence of injuries in senior synchronized dred and thirty-two skaters (25%) who initially started their Concussion skaters. Two types of injuries can be distinguished in all skating skating career with synchronized skating began to skate be disciplines - the acute defined as tissue damage that occurs at a tween the age of 6 and 14. Surveyed skaters from this research specific time, and overuse injuries, in which the time of occur started to train at a competitive level in synchronized skating rence cannot be exactly specified, and in most cases the skaters when they were between 8 and 21 years old. Four hundred and Others neither feels, nor remembers the time of initial tissue damage seventy-three skaters (90%) started to compete in synchronized [2,4,5]. For this purpose a questionnaire was used to collect data skating Uuvenile, novice, junior) when they were between 8 and on injuries in this developing ISU skating discipline. 15 years old, while only 53 skaters (10%) joined the team in their senior skating career at age between 17 and 21 yrs. The time spent for on-ice practice was variable between the teams. From,
Dubravcic-Simunjak S et al. Injuries in Synchronized Skating ... Int JSports Med 2006; 27: 493-499 juries within the locomotor system of these skaters we found Table 1 Absolute and relative (%) numbers of acute injuries in that 69 (13.4%) female and 2 (14.3%) male skaters had suffered P 2004 the synchronized skaters at different body parts that were from low back problems and 112 (21.8%) female and 2 (14.3%) d to all 23 studied male skaters had one or more overuse syndromes during their rs were re skating career. Out of 155 overuse injuries in female skaters, earns com Female Male Total 65.8 %(102 overuse injuries) occurred during their figure skating estionnaire (n =514) (n =14) (n=528) career, while only 34.2 %(53 overuse injuries) occurred in skaters hip held in after they joined synchronized skating teams or in those skaters equestion who initially started their skating career as synchronized skaters. mce, which In male skaters, where we found 5 overuse injuries. 4 of them ~sted to re (80%) occurred in their figure skating career, while 1 (20%) oc ,1ternation curred during his synchronized skating career. The localization Champion- and time of overuse injuries occurrence are shown in Table 5.
Synchronized skaters practice team and individual elements on If acute and and off the ice. Looking through the distribution of injuries in zed skating questionnared skaters, out of 412 injuries, 338 (82%) occurred hen the in during on-ice practice, while 74 (18%) acute injuries happened s. sU.rgery). !;'l3teamS, 4 of them spent 10-21 hours (4-6 times) per week during off-ice training. Ninty-one (26.9%) acute injuries occurred off the ice. I;participating in on-ice training. While other 20 teams spend 4 while teams were practicing individual elements in their skating nt age, the jg hours (2 - 5 times) per week participating in on-ice training. programs, and 247 (73.1 %) injuries that happened on ice oc when they ::]00 average, the best placed teams spend 15 hours in on-ice train curred while the team practiced different team elements (circle, )fthe ques i!h1g while other teams spend on average 6 hours in on-ice train line, wheel, intersection, block,lifts, others). Distribution of inju with refer ,'rg.AlI of the teams spent an additional 2 to 5 hours (3.5 hours in ries through team elements is shown in Table 6. ,line, inter Haverage) per week participating in off-ice training. IS, etc.) We The number of injuries increased during the last 4 skating sea ~t occurred 'llmong 514 female synchronized skaters 218 (42.4%) had suffer sons (Table 7). 'nized skat 'j ed from acute injuries during their synchronized skating career, ;katers. j(while among 14 male skaters 6 of them (42.9%) had acute inju The severity and type of injury determined the length of time ,ries while synchronized skating. The localization of acute inju that skaters had to interrupt their training and this time was re nto a com :ies is shown in Table 1. In Tables 2 - 4 the spectrum of acute in ported between 0 days and 6 months. Injuries were treated ei lS used for and their localization throughout the different body re ther conservatively or with surgery. In conservative treatment is presented. Some of the skaters, both males and females, different methods of physical therapy were used (RICE rest, had suffered from more then one injury dming their synchro ice, compression. elevation, stretching, strengthening, electro nized skating career, with median of 3 - 5 injuries per skater, pro stimulation of muscles, electrotherapy, laser, ultrasound, magne viding a total of 398 acute injuries in females and 14 acute inju to therapy. and others). Surgery was divided into two groups: ries in males. Two hundred and ninty-six (57.6 %) female and 8 major surgery and sutures for lacerations. Out of 88 laceration continents (57.1 %) of the male skaters did not have any injury in their injuries, 65 (73.9%) required sutures for closure, while 23 (and com 5ynchronized skating career. Reviewing the chance of overuse 1n (26.1 %) were so superficial that they were treated with primary mse a total ~ question-
Table 2 Absolute and relative numbers of acute head and trunk injuries in female (n =514) and male (n = 14) synchronized skaters who Jetween 15 were studied 'nm_~~~~~~~~~~~~~~~~~~~~~_____ 18 and 32). ------"--~ they were Head Neck Thoracic spine Lumbar spine Abdominal part IUr skaters :ed skating joined the ,One hun lrted their skate be is research ed skating ndred and lchronized veen 8 and 1m in their The time ams. From
Dubravclc·Simunjak S et al. Injuries in Synchronized Skating .. , Int JSports Med 2006; 21: 493 -499
--~-~-.. '--~ ----. iiiII Table 3 Absolute and relative (%) numbers of acute upper extremity injuries in female (n = 514) and male (n = 14) synchronized skaters who Table 5 Absol were studied - Upper arm Lower arm Shoulder Elbow Wrist Finger Total of arm injuries no and (%) F M F M F M F M F M F M F M - Hamstrings syr ::'M~m#~~'tMq~,;· Osgood Schlatl
Achilles tendin ·:.::WI#nfqt£b~~iij~ 4 11 2 32 2 Ankle impinge (24.2%) (50%) I /:~~f~~§cffp¢hJ~~ Total. no. and
8 24 19 1 18 29 1 34 2 132 4 " ______m (6.1 %) ______(18.2%) (14.4%) (25%) _ (13.6%) _~~~.~~, (1?~_ (1~~':" f ~ f f Table 6 Dist --bod skat Table 4 Absolute and relative (%) numbers of acute lower extremity injuries in female (n = 514) and male (n = 14) synchronized skaters who ------were studied bers
Upper leg Lower leg Hip Knee Ankle Foot Total of leg injuries no. and (%) F M F M F M F M F M F M F M -
Wheel Cantu5 11 19 2 3 40 1 sian (25.2%) (12.5%)
Circle Lacera- 5 11 2 4 10 30 3 tian (18.8%) (37.5%)
Lift Ligjme- 20 2 20 2 niscus (12.6%) (25%)
Total. -no. and (%) first aid only as there was no need for any surgical intervention. juries in elite synchronized skaters. obtained through a question The total number of fractures included 21 upper extremity frac naire. Although the response both from males and females was tures and 13 lower extremity fractures. There were 4 (19%) upper 100%. the low number of males participating in this study would Table 7 Th, extremity fractures and 5 (38.5 %) lower extremity fractures that make any interpretation ofthe results pertaining to male skaters - me required surgery. to be viewed with caution. The response of 100% is attributable to the full cooperation of team leaders. doctors. coaches. and Menarche in female skaters occurred between 10 and 15 years of managers. It has to be realized that a drawback of a question age (median age 13 years old). naire is that the recall of recent injuries is more accurate than . from injuries suffered some years ago. Unfortunately publica- • - tions on injuries in synchronized skating are lacking. Discussion Trunk. no. ( As we are not aware of published papers concerning synchro- ' Synchronized skating is mainly a female sport and out of 23 nized skating injuries. we can only compare our results with data Lower extre teams who participated in this study only 6 teams reported male that were orally presented by Mc Carthy and Micheli at ISU Med participants. This is the first study reporting the incidence of in- ical Congress held in Washington in March 2003 [8]. The number i
Dubravcic-Simunjak S et al. Injuries in Synchronized Skating ... Int JSports Med 2006; 27: 493 - 499
LI :l skaters who Table 5 Absolute and relative (%) numbers of overuse injuries in female (n =514) and male (n =14) synchronized skaters who were studied
During figure skating career During synchronized skating career Total, no. and (%) arm injuries If female male female male female male d(%} - M
1 ~) (25 %)
2 6) (50 %)
4 (1
"" IR' 1"llli'IIIdIIKJ_ of injuries as found in the present study are in line with those as Table 6 Distribution of acute injuries threw different region of the presented by Mc Carthy and Micheli [8] who repolted an injury body and their spread through the studied synchronized rate of 29.1 %at the ISU World Challenge Cup in Boston 1996 and I skaters who skating team elements with absolute and relative (%) num bers 62.9% injuries at the United States Figure Skating Association (USFSA) Synchronized Skating Nationals in 1998. They reported -- Head Trunk Upper Lower Total. a low prevalence of head injuries (4.6%). in general with no ,ofleg injuries 'nd (%) extremity extremity no.and specific details of the severity or type of injury. in the ISU World (%) 1996 1.2% 1998. M Challenge Cup in and in USFSA Nationals in while we found 19,8 % head injuries in female and 14.3 % in male skaters, who were classified into 4 groups - concussions. contu sions, lacerations. and other as shown on Table 2. Out of 81 head i Wheel 6 4 injuries only 12 (14.8%) of them occurred more than 4 years ago, %) while 69 (85.2%) occurred in the last 4 skating seasons. This sug gests that due to increasing demands put on synchronized skat ers in the last 4 skating seasons, the incidence of head injuries is 3 increasing. However, it cannot be ruled out that the recall of re %) (37.5%) cent injuries is more accurate than those suffered some years ago. Head injuries occurred mainly during the practice of on-ice team elements, especially in lifts, blocks, and intersections. 2 ;t;) (25%) Smith and Ludington [11] reported in elite pairs and ice dance skaters 11 serious injuries that were caused by lifts. In previous
66 22 80 79 247 research [5] in elite junior figure skaters, head injury occurred (26.7%) (8.9%) (32,4%) (32%) (100%) in 8 (13.1 %) females and 5 (8.2%) male pair skaters, and in 1
1 a question females was study would Table 7 The incidence of acute injuries with absolute and relative (%) numbers due to time of its occurrence in studied female (n 514) and nale skaters male (n = 14) synchronized skaters
~11~.__ ~ffi'~. _____ attributable oaches, and Less than 4 years ago More than 4 years ago Total a question no.and(%} no.and(%} no. and (%) curate than female male female male female male ~ly publica-
Ig synchro ts with data at ISU Med rhe number
Dubravdc-Simunjak S et al.lnjuries in Synchronized Skating ... lntJ Sports Med 2006; 27: 493-499 (1.5%) male ice dancer. Brown and McKeag [3) reported that lift male skaters were reported, most of them occurred before those 4 Danowski RG, l Barcelona: Mas related injuries in pair skaters mostly included contusions, lacer skaters joined synchronized skating teams (Table 5). In this reo 5 Dubravcic-Siml ations, fractures, haematomas, and muscle strains. In this re spect synchronized skaters are similar to ice dancers and cidence of injt search we found that among synchronized skaters reported head skaters in which acute injuries are more common than overuse 2003; 31: 511 injuries included not only contusions, haematomas, and lacera ones [5,10,11]. In single figure skaters (men and women) most International S tions, but also the incidence of concussions. of their training time is spent on training 6 different triple jumps ing 2002. taus. 7 ISU Synchroni; and one or two of those as quadruples. Due to uncontrolled rep sanne, Switzer Among trunk injuries, the majority were located over the lumbar etitions and microtrauma of lower extremities overuse spine (Table 2). Mc earthy and Micheli [8] reported 20.2% of are seen in those skaters more often than the acute ones upper extremity, 58.4 %of lower extremity, and 14.5 %of trunk in juries in USFSA Synchronized Skating Nationals, while we found Pairs and ice dancers spend most of the training time on practi0 33 %of upper, 40.5 %of lower extremity, and 6.8 %of trunk inju ing different pair elements lifts, throws, pair spins, steps, and ries with major prevalence in the last 4 skating seasons, as holds. To gain extra credit and points. those elements have to be shown on Table 7. Most of the trunk, upper, and lower extremity original and performed in unison, both in pairs and in ice injuries that occurred on ice, occurred while the skaters were dancers. Synchronized skaters work in their practice on differeJl <1'-'1'-"'15 intersection and block team elements, which require team elements (blocks, circles, intersections, wheels, Iifts...i a great deal of coordination, unison, and precision to execute which require good posture, skating skills, coordination, anj successfully. Reviewing the overall lower extremity injuries in timing. In spite of the many repetitions they do not lead to gre2: ' synchronized skaters, the majority ofthem are knee injuries (Ta impact or microtrauma on the lower extremities. So, the most ble 4), mostly ligament/meniscus injury, contusions, haemato likely explanation for the occurrence of the two different typel mas, and lacerations, while in a previous study [5] we found that of injury is the difference in training routine between those skat· among pairs and ice dancers knee injuries are a minority com ing disciplines. pared to the other acute injuries. In figure skaters, among acute injuries, the prevalence of ankle sprains is greater than 50%, as Our results show that the number of low back problems are sim· reported by Authrosen [1], Bloch [2]. Danowski [4], and Dubrav ilar to those found in other figure skating disciplines [2,4,5,91. cic-Simunjak et al. [5), while in the present study we found that Omey and Micheli [9] found that besides overuse and acute i~u in synchronized skaters the incidence of anlde sprains/strains ries, low back pain was the most frequent complaint seen in sin· was only 19.5% in female and 25% in male skaters. During their gles and pair figure skaters. training figure skaters practice dOUble, triple, and quadruple jumps on and off the ice, and due to failures in clean landings Looking through the injuries that occurred in surveyed skateT, ankle sprains occur quite often in that skating discipline. In we noticed that the best-placed teams (medal had low· synchronized skating, jumps are limited to single rotations in er rate of injuries than teams placed from 4th to 23rd place. which ankle sprains usually do not occur. However synchronized skaters are subject to ankle sprains when they are practicing Limitations of this study are its retrospective and lacko' J some of the team elements, mostly off the ice, but these ele data from other studies reporting synchronized skating injurie~ J ments are at a much lower risk of ankle sprain than the risk asso however, this is the first one presenting injury data in this skar· ; ciated with multirotational jumps. Hence, the rate of ankle ing discipline. sprains is much lower in synchronized skating than in figure skating. In conclusion, we would like to stress that the current available data suggests that the number of acute injuries has Of all upper extremity injuries recorded in synchronized skaters, the past 4 skating seasons, although it cannot be ruled out the most commonly found were finger injuries, followed by wrist the numbers have been biased by a better recall of recent injuries and then by lower arm injuries being the third most ries. Although it is tempting to suggest that the increase common upper extremity injury reported (Table 2). In a previous cides with increased demands for more technically difficult ele· study [5] in junior figure skaters, out of 258 pair skaters and ice ments performed by the synchronized skaters, this rfH1rlll<,"' only 17 (6.6%) reported upper extremity injuries, while should be treated with caution. Nevertheless, we strongly rec· none was found among 211 single men and women figure skat ommend that the medical community work closely with ers. The injuries recorded in this study of synchronized skating coaches, skaters, and technical committees in future develop, are easily comprehended given the large number of skaters si ment of synchronized skating. multaneously on the ice performing different elements and holds presenting demanding elements synchronously. Most of the upper and lower extremity injuries occurred in intersections References in which one part of the team moves through or along the re maining of the team. The second most common circum 1 Authorsen S, Wingendorf M, Weyer R. Boot related injuries as seen at: stance where injuries occur are when the skaters are moving as the Olympic Training Center, Dortmund, Germany, in ISU Internation· al Congress on Medicine and Science in Figure Skating. Lausanne. units along the ice in blocks in varying shapes of three or more Switzerland: ISU, 1997: 15 lines. 2 Bloch RM. Figure skating injuries. Phys Med Rehabil Clin NAm 1999: 10: 177 -188 In synchronized skating overuse injuries are not as common as 3 Brown E, McKeag D. Training, experience, and medical history of pairs skaters. Physician Sportsmed 1987; 15: 100-114 acute ones. Although 155 overuse injuries in female and 5 in
Dubravcic-Simunjak S et al.lnjuries in Synchronized Skating .•. IntJ Sports Med 2006; 27: 493-499 d before those 4Danowski RG, Le Blond j. Medecine des sports de glace. Paris, Milan, 8 Micheli L1, McCarthy CF. Synchronized team skating - Optimizing 5). In this re Barcelona: Masson. 1997 training and preventing injuries. Washington, DC: ISU Medical Con 5 Dubravcic-Simunjak S. Pecina M, Kuipers H, jane M, Haspl M. The in lcers and pair gress Presentation, March 2003 cidence of injuries in elite junior figure skaters. Am j Sports Med 9 Omey ML, Micheli Lj. Gerbino PG n. Idiopathic scoliosis and spondy than overuse 2003; 31: 511-517 lolysis in the female athlete. Tips for treatment. Clin Orthop ReI Res women) most . S International Skating Union. Special Regulations Synchronized Skat 2000; 372: 74-84 It triple jumps . ing 2002. Lausanne, Switzerland: ISU, 2002 10 Pecina M, Dubravcic S, Bojanic I. Stress fractures in figure skaters. Am 11SU Synchronized Skating Technical Committee. Media Guide. Lau j Sports Med 1990; 18: 277 - 279 ontrolled rep sanne, Switzerland: ISU TC, 1999 11 Smith AD, Ludington R. lnjures in elite pairs skaters and ice dancers. eruse injuries Am] Sports Med 1989; 17: 482-488 ~ ones [5].
ne on practic 115, steps, and nts have to be 's and in ice :e on different heels, lifts ... ) dination, and clead to great So, the most ifferent types ~n those skat lems are sim les [2.4.5,9J. Id acute inju It seen in sin-
eyed skaters. ers) had low rd place. n and lack of ting injuries, in this skat
2nt available increased in lIed out that recent inju crease coin difficult ele ; conclusion trongly rec ;ly with the Ire develop
ies as seen at rInternation 19. Lausanne,
IN Am 1999;
story ofpairs
Dubravclc-Simunjak S et al. Injuries in Synchronized Skating ... Int] Sports Med 2006; 27: 493-499