BrJ Sports Med 1997;31:205-208 205

Orienteering competition injuries: injuries Br J Sports Med: first published as 10.1136/bjsm.31.3.205 on 1 September 1997. Downloaded from incurred in the Finnish Jukola and Venla relay competitions

P E Linko, HK Blomberg, H M Frilander

Abstract in 1985. McLean' presented data on first aid Objectives-The aim of this study was to visits at the Scottish six day event in 1989 and find out the amount, type, and localisation the Jan Kjellstr6m memorial event in 1990. of acute orienteering injuries in the 1995 Hintermann and Hintermann4 studied the Finnish Jukola (men's) and Venla (wom- injuries requiring first aid treatment during the en's) relay competitions with 9724 partici- Swiss six day event in 1991. In these races there pants. were 1.4-5.3 injuries per 100 competitors. Methods-Patient data were collected on a Ekstrand et al' investigated the injuries in the preplanned form at the first aid station. Swedish O-ringen five day event in 1987, and Results-There were 244 acute competi- the total incidence of all injuries was 7.3/1000 tion injuries. The overall injury incidence competition hours. was 2.5% (95% confidence interval (CI) 2.2 Most of the injuries in these studies were to 2.8), 2.3% in the men's relay and 3.2% in mild cuts and wounds. Ankle sprain is a typical the women's relay, and the difference injury in orienteering accounting for 15-24% between incidences among men and of acute competition injuries.' 56 No differ- women was statistically significant (odds ences between male and female orienteers with ratio (OR) 1.4; 95% CI 1.1 to 1.9). The regard to injury rates have been found. ' 8 injury rates were also calculated per 1000 Almost all patients could be treated in the first competition hours and per 1000 km and aid stations, and only 1.6-2.6% had to be were 15.4 and 2.6 respectively. Most of the admitted to hospital for further investigations.' 4 injuries could be treated at the first aid Jukola relay is a seven leg relay competition station. Female orienteers had more blis- at night for male orienteers, and Venla relay is ters (OR 4.4; 95% CI 2.5 to 7.9) and fewer a four leg daytime relay for women. Both relays

wounds (OR 0.5; 95% CI 0.2 to 1.0) than have a mass start. These are the biggest one day http://bjsm.bmj.com/ male orienteers. Injuries occurred mostly orienteering events in Finland. Among the in the lower extremities (70%), and ankle competitors there are both world class orien- sprains accounted for 25% of all injuries. teers who run for victory and a large number of Injuries were more common during the recreational orienteers. first leg ofboth relays. The aim of this study was to find out the Conclusions-This study shows the heavy amount, type, and localisation of acute orien- workload in a first aid station of a big ori- teering injuries in the Finnish Jukola and Venla enteering relay competition. It indicates a relay competitions. on September 27, 2021 by guest. Protected copyright. Department of difference in injuries between the sexes Orthopaedics and and in the different stages of the relay, Traumatology, which should be further investigated in Methods Helsinki University to Central Hospital order prevent orienteering competition In 1995 the 47th annual "Jukolan viesti" and P E Linko injuries. 18th "Venlojen viesti" took place in Sipoo, in (BrJ Sports Med 1997;31:205-208) Southern Finland. There were 9724 partici- Department of pants in 1107 male and 597 female teams from General Practice and Keywords: orienteering; acute injuries; injury incidence Primary Health Care, 15 different countries. The women's competi- Helsinki University tion started at 1450 and the men's at 2225. The H K Blomberg length ofthe legs varied in the men's relay from Orienteering is an endurance sport in which 8.0 to 14.1 km and altogether the men's course Dragsvik Garrison the competitors must find their way through was 75.2 km long, and in the women's relay the Hospital varied from 5.5 to 8.2 km H M Frilander unknown terrain navigating between pre- legs and the whole marked control points using a compass and a course was 26.8 km long. The weather was Correspondence to: map. cloudy and dry. The sun set at 2243 and rose at HK Blomberg, Department There are only a few reports on orienteering 0357. The terrain was both technically and of General Practice and Primary Health Care, PO competition injuries and most of them deal physically very demanding, with especially Box 50, FIN with multiday events. Folan' reported the inju- intricate rock shapes and some steep slopes. 00014,University of Helsinki, ries at the Irish National Orienteering Cham- The terrain was typical for southern Finland: Finland. pionships in 1981. Korpi et a!' studied the mixed forest where the visibility and "runabil- Accepted for publication injuries in a five day FIN-5 event in 1984 and ity" was good except for some slopes with 28 May 1997 the Finnish night orienteering championships thicker forest and bushes. The terrain was 206 Linko, Blomberg, Frilander

similar in all legs. During the three first legs in to 1.9). The fastest female team was in the for- the men's relay a halogen head lamp was used est for 3.3 hours, the slowest for 8.5 hours, the Br J Sports Med: first published as 10.1136/bjsm.31.3.205 on 1 September 1997. Downloaded from by most competitors because of dusk and total exposure time was 2728 hours and the darkness. injury rate was 27.1/1000 competition hours. The first aid station was near the start/finish The fastest time in the men's relay was 9.0 area and was continuously manned by at least hours, the slowest 28.3 hours, the total three doctors, nine nurses, and a exposure time was 13 086 hours and the injury physiotherapist. They all worked on a voluntary rate was 13.0/1000 competition hours. The basis. In the first aid station it was possible to women's injury rate was higher than the men's clean and dress wounds, suture cuts, give cool- even when the competition time was consid- ing and taping therapy, and give intravenous ered (OR 2.1; 95% CI 1.6 to 2.8). The overall fluids and medication. Resuscitation was also injury rate was 15.4/1000 competition hours. possible. Local Red Cross personnel had three In the women's relay the total distance run was additional first aid units without a doctor. 15 202 km and the injury rate was 4.9/1000 Name, date of birth, gender, address, km, and in the men's relay the total distance diagnosis, treatment, registering time, and was 79 973 km and the injury rate was leaving time were collected on a separate form 2. 1/1000 km. On an average competition kilo- for each patient at the first aid station. Later the metre, the risk of injury to women was higher competitor status (competitor/ not competitor) than to men (OR 2.3; 95% CI 1.7 to 3.0). The of the patient, the relay leg on which the injury overall injury rate was 2.6/1000 km. occurred, and the result of the team were Figure 1 shows the workload of the first aid checked from the results lists. The ages of the station. About one hour after both starts there competitors were not registered. was a rise in the number of patients contacting Cross tabulation, X2 tests, and logistic the first aid station. Most of the visits were regression were used in the statistical analyses. caused by competition injuries in the race. Significance was accepted at the 5% level Competitors also contacted the first aid station (P<0.05). A confidence interval of 95% (95% with other medical problems (competitors CI) is generally shown in connection with treated for other reason)-for example, aller- statements concerning proportions. The data gies, headache, infections, and injuries in- were processed by the SAS 6.1 and Excel 5.0 curred before the competition. Also officials software. and spectators (non-competitors treated) were treated at the first aid station for similar reasons. Most of the visits made for reasons Results other than competition injuries took place The first aid station was visited by 417 patients before the men's race. of whom 360 were competitors (3.7 visits/100 The risk of injury was significantly greater competitors), and 244 (170 men and 74 during the first leg than the last leg in both women) of these were the result of acute relays. In the men's relay the risk of injury trauma in the competition. Officials and seemed to decrease from the first to the last leg http://bjsm.bmj.com/ spectators made 57 visits to the first aid station. (table 1). The injury incidence was 2.5/100 competi- Competition injuries occurred most com- tors (2.5%). The incidence of competition monly in the lower extremities (70%). The most injuries was higher in women (3.2%) than in frequent injuries were blisters in women and men (2.3%) (odds ratio (OR) 1.4; 95% CI 1.1 small wounds in men (table 2). Women had on September 27, 2021 by guest. Protected copyright. Start of women's Start of men's Sunset Sunrise 303O0 relay (1450) relay (2225) 4l (2243) (0357) - Competition injury 25 v E Competitor treated for other reason - Non-competitor treated

zuOnAu c CO0 15J 0r. 0 15 -0 E Z 10

5

0 10 11 12 13 14 15 16 17 18 19 20 21 22 23 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Check in time

Figure 1 Patient load according to patient checking in time (n =364). Orienteering competition injuries 207

Table 1 Competitor's risk ofinjury in different legs ofthe relay Br J Sports Med: first published as 10.1136/bjsm.31.3.205 on 1 September 1997. Downloaded from Competiors Mean leg 95% Confidence Injury rate Leg distance (km) Total (n) Injured (n) Odds ratio* interval (Nol1000 km)

Men's race 1 9.9 1107 39 1 3.6 2 11.8 1092 32 0.8 0.5 to 1.3 2.5 3 12.9 1071 27 0.7 0.4 to 1.2 2.0 4 8.1 1057 21 0.6 0.3 to 1.0 2.5 5 8.1 1053 19 0.5 0.3 to 0.9 2.2 6 10.4 1045 14 0.4 0.2 to 0.7 1.3 7 14.1 1018 16 0.4 0.2 to 0.8 1.1 Total 75.3 7443 170 1 2.1 Women's race 1 5.6 597 29 1 86 2 5.6 577 11 0.4 0.2 to 0.8 34 3 7.5 565 21 0.8 0.4 to 1.3 50 4 8.1 542 13 0.5 0.2 to 0.9 30 Total 26.8 2281 74 1.4t 1.1 to 1.9 4.9 * Odds of getting injured compared with the first leg. t Women's odds of getting injured compared with the odds of the men.

Table 2 Competition injuries among men and women. Numbers in parentheses are percentages

Injury Gender Wound Bruises Blisters Sprain Eye injury Other Total Men 56 (33) 26 (15) 20 (12) 52 (31) 12 (7) 4 (2) 170 (100) Women 8 (11) 12 (16) 27 (36) 22 (30) 5 (7) 0 (0) 74 (100) Total 64 (26) 38 (16) 47 (19) 74 (30) 17 (7) 4 (2) 244 (100) X2 = 27.774, df = 5, P < 0.0001.

significantly more blisters (OR 4.4; 95% CI 2.5 injured competitors or 1.4% of all the patients to 7.9) and fewer wounds (OR 0.5; 95% CI 0.2 were taken to a hospital. to 1.0) than men. Ankle sprains accounted for 25% (n = 60) of all competition injuries, and Discussion there were 3.8 ankle sprains/1000 competition The injury incidence of 2.5% in these relays is hours and 0.6 ankle sprains/1000 km. comparable with the incidences in individual In the men's the risk of In this we had 15.4 acute relay getting sprains competitions." study http://bjsm.bmj.com/ was greatest during the first leg (7 of 52) and injuries/1000 competition hours. Ekstrand et differed significantly from all other legs except al5 reported 7.3 acute injuries/1000 competi- the third and the fifth. Most of the sprains (42 tion hours in a five day race, but the injuries of 52) were ankle sprains and most of these that were treated by personnel other than doc- (15) occurred during the first leg of the men's tors are not given. Johansson's study of elite relay. There were more wounds in the first orienteers showed 1.3 acute injuries/1000 three legs in the men's relay but the difference training hours during a one year study period.7

was not statistically significant. The injury rate It is understandable that there are fewer on September 27, 2021 by guest. Protected copyright. did not correlate with the result of the team. injuries during training, and it is likely that the Fifteen men and one woman had to stop the elite orienteers did not report injuries that did race because of injury. These competitors had not interrupt their training. In our study there 11 ankle sprains (69%), two wounds, one was a higher incidence of injuries among shoulder and one elbow dislocation, and one women than men, and this difference was shin contusion. accentuated when the injury rate was related to The most frequent treatment procedures the competition time or distance. This may were cleaning and dressing small cuts and indicate that the risk of injury is different dur- bruises, cooling therapy, taping of ligament or ing different phases of the race and thus there muscle injuries, and wound suturation. The may be some difficulty in comparing the injury most frequently ordered drugs were anti- rates in relation to time or distance when there inflammatory analgesics and antiallergy medi- are races of different durations. cines. One 46 year old male orienteer had acute Previously no difference in competition myocardial infarction after finishing his relay injury incidence and type has been found leg and was successfully resuscitated from ven- between male and female orienteers.' 7In the tricular fibrillation in the finishing area and study of Kujala et al,8 which was based on ori- admitted to a hospital for thrombolytic therapy. enteering licence insurance records, women Other causes for transferring a patient to a had more ankle sprains and men more wounds. hospital for further examination and treatment In our study female orienteers had a higher were one elbow dislocation, one suspected incidence ofinjuries and they had more blisters ankle fracture, one eye wound, acute abdomi- than male orienteers, which may be due to nal pain in one orienteer, and exhaustion ofone inappropriate orienteering shoes or fewer female orienteer. Thus six or 2.5% of the training hours or perhaps women seek first aid 208 Linko, Blomberg, Frilander

more quickly than men. As in the study of also the most usual injury that led to Br J Sports Med: first published as 10.1136/bjsm.31.3.205 on 1 September 1997. Downloaded from Kujala et al,8 wounds were more common in discontinuation of the race. Much attention male orienteers, which is probably caused by a should be given to the prevention ofankle injur- more direct and aggressive running technique. ies in orienteering, including prophylactic In both sexes there was a predominance of ankle disk training and the use of prophylactic injuries during the first leg. It is possible that ankle taping or ankle stabilisers.1"1' the physical strain of a mass start and the excitement at the beginning of the relay The authors thank Dr Tapani Alkula, Department of Sociology, produced more injuries on the first leg than on Helsinki University, for his valuable comments. were not allowed in the other legs. Spiked shoes 1 Folan JM. Orienteering injuries. Br J Sports Med first leg in these relay competitions and this 1982;16:236-40. eliminated the injuries caused by spikes, but on 2 Korpi J, Haapanen A, Svahn T. Frequency, location, and types oforienteering injuries. ScandinavianJournal ofSports the other hand it might have resulted in more Science 1987;9:53-6. injuries caused by slippery terrain. In the men's 3 McLean I. First aid for orienteering in Scotland. Scientific Journal of Orienteering 1990;6:55-63. relay, the darkness during the first three legs 4 Hintermann B, Hintermann M. Injuries in orienteering. A may also have contributed to a greater study ofthe Swiss 6-days orienteering event. Scientific Jour- nal of Orienteering 1992;8:72-8. incidence of injuries. Although the last legs in 5 Ekstrand J, Roos H, Tropp H. The incidence of ankle both relays were longest, the fewest injuries sprains in orienteering. Scientific Journal of Orienteering 1990;6:3-9. occurred, which could be explained by the ori- 6 Hintermann B, Hintermann M. Ankle sprains in enteers over a broader time scale orienteering: a simple injury? Scientific Journal of Orienteer- being spread ing 1992;8:79-86. when starting this leg. 7 Johansson C. Injuries in elite orienteers. Am J Sports Med A consideration of the difference in injuries 1986;14:410-15. 8 Kujala UM, Nylund T, Taimela S. Acute injuries in incurred by women and men and in different orienteering. IntJ Sports Med 1995;16:122-5. stages of the relay may have some importance 9 Linde F. Injuries in orienteering. Br J Sports Med 1986;20:125-7. in the prevention of injuries but this needs 10 Tropp H, Askling C, Gillquist J. Prevention ofankle sprains. more investigation. Am J Sports Med 1985;13:259-62. 11 Rovere GD, Clarke TJ, Yates CS, Burely K. Retrospective Ankle sprain is a typical injury in orient- comparison of taping and ankle stabilizers in preventing 9 In our study, 25% of injuries were ankle injuries. Am J Sports Med 1988;16:228-33. eering.3 5 6 12 Gauffin H, Tropp H, Odenrick P. Effect of ankle disk train- ankle sprains and there was a predominance of ing on postural control in patients with functional instabil- ankle sprains in the first leg. Ankle injuries were ity of the ankle joint. IntJ Sports Med 1988;9:141-4.

Sports medicine in primary care The New England Baptist Hospital sports viral agents we dressed in full length water-

medicine department organised their first proof theatre gowns, protective shoes, http://bjsm.bmj.com/ annual course in sports medicine in primary gloves, and goggles. Inside the laboratory we care in 1997. It was a new initiative for them examined a cadaver, dissected to show the as they had few previous links with family injuries about which we had learnt in the doctors or physiotherapists in the commu- morning. Anatomy seemed much more nity. The two day course began with interesting than it ever did in medical continental breakfast at 7 30 am to gather school! In the next room they had arranged the participants for the 8 am lecture. The cadaveric knees and shoulders to allow us to course was designed to make an anatomical insert arthroscopes. We revised our surface on September 27, 2021 by guest. Protected copyright. tour of all sports injuries of the upper and anatomy, and could inject knees and shoul- lower limb, and included back pain for good der joints and see the needle tips on the measure. Orthopaedic surgeons and physio- arthroscope. We closed the afternoon with therapists alternated their presentations so practical revision of joint examination on that injury and rehabilitation were covered human (live!) subjects. in tandem. The speakers rattled through the It was a superb, if very concentrated slides so fast that ifyour attention drifted for course. The local GPs thought it was a moment you would wake up in a different expensive at $425 for two days and it would joint. In mitigation, the hand outs were be prohibitively expensive to travel from the exceptional and as good as many textbooks. UK for such a short time, but it was an In the afternoon sessions we were taken to excellent course, which I would thoroughly the Bioskills laboratory-an exceptional recommend. The teaching facility itself is facility that is a hybrid of an anatomy labo- well worth a visit and is one of few similar ratory and an orthopaedic theatre. After facilities in the United States. signing a comprehensive medicolegal waiver concerning AIDS, hepatitis, and any other DOMHNALL MACAULEY