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Objective: To describe the injury and illness complaints of elite athletes during the four weeks before the 2022 European championships in Munich (Germany).Methods: We conducted a cross-sectional study in athletes registered at the 2022 European championships from the 11th to the 21st August 2022, using an online pre-participation health questionnaire (PPHQ) asking about personal and training characteristics and injury and illness complaints during the four weeks preceding the championships.Results: Among the 5419 registered athletes, 239 (4.4%) completed the PPHQ. A total of 47 athletes (19.7%) reported an injury complaint during the four weeks before the championships. The most frequently reported worst symptom was pain (59.6%), location was upper extremity (19.1%), followed by posterior thigh (12.8%) and head/trunk (12.8%). The mean injury severity score (ranging from 0 to 100) was 39.420.2. About two-thirds of athletes reported performance not or only slightly affected by the injury complaint. Twenty-five athletes (10.5%) reported an illness complaint prior to the championships. The most frequently reported affected system was respiratory tract (52.0%), cause was infection (64.0%), and the mean illness severity score was 35.517.7. 80% of athletes reported that the performance was not or only slightly affected by the illness complaint.Conclusion: About 20% of included athletes reported an injury complaint and about 10% an illness complaint during the four weeks before the 2022 European championships. These results highlight the need of improving the monitoring and if needed, the management of athletes health, in the final preparation for international championships.Key Words: Sports Injury Prevention, Pre-Competition Medical Assessment, Injury/Illness Surveillance, Epidemiology, Championships

Bone stress injuries, commonly referred to as stress reactions or stress fractures, are caused by overuse and are prevalent conditions in athletes. These injuries are often seen in sports with high cumulative skeletal loading such as running, athletics, gymnastics, basketball, cricket, or soccer. The main injury pathophysiology is an imbalance between bone microdamage formation and its removal and replacement. A detailed medical history and clinical examination are important for diagnosis, with magnetic resonance imaging representing the gold standard for radiographic confirmation. Treatment and return-to-sport decisions should be individualized and based on injury location, severity, aspects of sports participation, and patient preferences. Initial management includes activity modification, protected weight-bearing, immobilization, optimizing nutrition (caloric intake, dietary calcium, and vitamin D supplementation), and in a few cases surgery. Following initial treatment, progressive loading and return-to-activity are initiated. Overall, a high rate of return-to-sports can be expected. Numerous risk factors that alter bone loading or bone health have been described and their identification is a crucial step towards prevention of future injury.Key Words: Stress Reaction, Stress Fracture, Bone Overuse

Problem: The first metatarsophalangeal (MTP) joint can become painful in runners and limit ability to remain active. Extracorporeal shockwave therapy (ESWT) is a conservative treatment option for musculoskeletal disorders due to its proposed effect on tissue remodeling and pain modulation and is best combined with physical therapy (PT). We hypothesized that a portion of runners with first MTP pain treated with ESWT and PT would achieve functional improvements.Methods: Chart review identified 21 runners who received ESWT and PT for first MTP joint pain. Functional outcomes were quantified using the Foot and Ankle Ability Measure (FAAM) prior to and following treatment, and patients meeting minimally clinically important differences (MCID) was the primary outcome of interest. Each runner received a minimum of three sessions of ESWT over the MTP joint, and PT focused on intrinsic foot strengthening and joint mobilization.Results: MCID was achievable in either FAAM ADL and/or FAAM Sports subscales for 15 of 21 runners, of whom 9 of 15 (60%) met MCID in one or both subscales. FAAM Sports subscale improved from pre-treatment median of 12 to best post-treatment median of 23 (p=0.0049) after a median time of 3 weeks.Discussion: ESWT combined with PT may be an effective and well-tolerated treatment for runners with first MTP joint pain in whom other conservative management has failed. Most included runners treated with ESWT and PT had improved function. Key Words: Foot, Running, Rehabilitation

Problem: Injuries in athletics are common and may lead to restrictions in athletics participation and performance. We thus aimed to describe the epidemiology (prevalence, incidence, burden, characteristics) of injuries self-reported by the athletes (injury complaint leading to participation restriction (ICPR)) in athletics athletes) over one athletics season. Methods: For this study, we used data from the PREVATHLE randomized controlled trial and only from athletes of the control group who provided 100% of the weekly responses. On a weekly basis, we collected individual information via a questionnaire on the preceding week: number of hours of training and competition, and any ICPR (circumstance, mode of onset and location). The primary outcome was ICPR.Results: Overall, full data sets were available for 100 athletes. One hundred twenty-seven ICPR were reported from 65 athletes over the season, corresponding to a prevalence rate of 65 ICPR per 100 athletes (95%CI: 55.7-74.3). The incidence rate was 8.3 ICPR per 1000h (95%CI: 6.9-9.7), the overall injury burden was 285.6 (SD=619.6) days with an ICPR per 1000h, and the time before the first ICPR was 12.4 (SD=10.4) weeks. Most acute injuries occurred at the ankle (9.4%), while most overuse injuries occurred at the lower leg (15.0%).Conclusion: This present epidemiological study describes in detail the epidemiology of ICPR in athletics athletes over one whole athletics season, representing an additional piece to better understand the extent of injury problem in athletics.Key Words: Musculoskeletal Pathologies, Prevention, Monitoring

The prevention of infections is essential to athletes health and performance. Even mild infections can severely affect athletic performance and the eligibility to train and compete. One of the most effective means of avoiding severe infections are vaccinations. However, like the general population, athletes frequently do not receive the recommended vaccinations. This shortcoming is largely based on fear of adverse vaccine reactions, concerns about the efficacy, misinterpretations, negligence, and poor communication. As sports medicine physicians are involved in the regular screening of adolescent, adult, and senior athletes, they are in a unique position to advise on an individual basis about the risks and benefits of an athlete-specific vaccination schedule. Thus, every preparticipation physical examination should be used to check the vaccination status and, if needed, optimize and update the athletes vaccination profile. In this clinical review, recommendations for standard, travel, and specific-indication vaccinations in athletes will be given and their efficacy, timing, and administration in the sports context will be discussed. The review will be completed by recommended literature and useful apps for the sports medicine physician involved in the preparticipation physical examination of athletes.Key Words: Standard Vaccinations, Travel Vaccinations, Indication Vaccinations, Tetanus, Diphtheria, Pertussis, Measles, Mumps, Rubella, Hepatitis A/B, SARS-CoV-2, Influenza, Tick-Borne-Encephalitis, Sports

Introduction: An infection with SARS-CoV-2 is relevant especially in high-performance sport due to possible organ damage and reduced performance which occurs in individual cases. Various recommendations are found in the literature concerning when safe return to sports is possible and what examinations are suitable to support this decision. The dominance of other virus variants than those at the start of the pandemic makes revision of earlier recommendations necessary. Methods and Analysis: The recommended actions are based on the currently-available scientific knowledge of the pathogenicity of the virus and on clinical experiences in general and elite athletes. Twenty-one recommended actions were proposed by the Scientific Council of the DGSP, discussed and agreed on in consensus with experts from German-language sports-medical facilities and evaluated by an independent co-author. The resultant position paper was subsequently released by mutual agreement. Results: The recommendations are oriented to the severity of the course and the symptoms. The required medical diagnostic is deduced therefrom. During persistent symptoms, sports should be paused and training only begun again at low intensity after a three-day symptom-free period. If COVID-19-associated complaints recur, physical exertion should be stopped and a doctor consulted. After moderate and serious course, medical diagnostics are required prior to the start of training. Summary: To prevent a health risk due to sports and thereby resultant organ damage after a SARS-CoV-2 infection, a procedure adapted to the symptoms and course before return to training and finally to competitive sports is recommended.

* Problem: Recent research indicates an increased risk of neuropathologic changes in former elite contact team sports athletes possibly due to repetitive mild traumatic brain injury. Impaired neuro-ophthalmological function has been linked to mild traumatic brain injuries which can be detected using eye tracking. The aim of this project was to assess the reliability of a novel eye-tracking device using virtual reality (VR), and to analyze the acute effects of repeated headers on the neuro-ophthalmological function of competitive football players. * Methods: A reliability study with 50 healthy participants (26.7 years, 70% females) and an interventional cross-over study with 50 competitive football players (23.9 years, 50% females) were conducted. Overall, 29 parameters from 7 different VR eye-tracking tasks were computed. * Outcomes: The reliability assessment revealed poor reliability for most parameters (75% poor, 22% moderate, 3% good). The four most reliable parameters were analyzed in the interventional study and did not reveal significant differences (directional error: p=0.39, gain of the first saccade: p=0.56, latency of the first sac-cade: p=0.59, gaze velocity: p=0.73) between a header-focused training session and one without opponent contact or headers. * Conclusion: Our results show that technical challenges still exist to provide sideline availability of an objective neuro-ophthalmological screening in near real-time. Further research is needed to provide insight into the acute and long-term effects of repeated headers in football. [ABSTRACT FROM AUTHOR]

Problem: Little is known about health complaints and their prevention in elite wheelchair basketball. The study aimed to survey training environment and health complaints of elite wheelchair basketball players in the 12 months prior to the Wheelchair Basketball World Championships 2018 (WBWC).Methods: Players answered an anonymous retrospective questionnaire on match and training exposure, daily training environment, injury prevention as well as health problems and their implications in the 12 months before the WBWC.Results: In the 12 months prior the WBWC, 46.2% of athletes struggled at least sometimes with physical complaints, and 15.9% played often/always with pain or health complaints. Half of the players (50.8%) did not modify the volume of their training when having health complaints. Sixty percent of the athletes reported that injury prevention exercises were often or always part of their training. The overall training environment and national team support was rated as good or very good by 89.7% and 69.1% of players, respectively. Discussion: Prior to the world championships, wheelchair basketball players reported a high rate of pre-competition health complaints despite good training environment and the use of preventive strategies. Most players indicated they continued to play with pain and health complaints. Frequently playing with health complaints is known from other Olympic sports or pedestrian basketball. Prospective surveillance systems are needed to identify health complaints early and to examine efficiency of preventive measures in order to improve health and probably performance of wheelchair basketball players.Key Words: Paralympic Sports, Sports Injury, Injury Prevention, Trainings Conditions, Elite Athletes

Problem: The technology of inertial measurement units (IMU) enables the collection of running biomechanical data under in-field conditions. This paper presents a validation study of an increasingly used IMU system using a corresponding below-ground magnetic timing gate system.Methods: Thirty active healthy participants ran with an IMU located at the lumbar spine on a 60 m-section of a 400 m tartantrack. The IMUs were connected with magnetic timing gates installed below the tartan track. A photoelectric cell reference system was used for comparative analysis. Outcome measures were running speed, step length and cadence during running at slow and fast velocity. Intra-Class-Correlation (ICC), Bland-Altman analysis and regression-based Bland-Altman analysis were used to determine measurement agreement. Results: The analysis showed high measurement agreement for running speed, step length and cadence for both velocities (ICCs 0.745-0.996). Bland-Altman analysis showed high random errors and increased systematic and random errors for step length and cadence atfast running velocities. Regression-based Bland-Altman analysis indicated a systematic increase of bias (systematic error) with higher step length values.Discussion: Despite a high measurement agreement expressed by ICCs, study results also showed high error values for absolute measurements expressed by systematic and random errors for all parameters. Therefore, attention should be given to thecomparability of both measurement systems. Further research should focus on details of step length calculations as well as reliability and validity underlonger running conditions. KEY WORDS: IMU, Running, Cadence, Step Length, Biomechanics

The footstrike patternof an athlete is understood as the way the foot touches the ground. Over the years, several definitions and techniques to classify and quantify footstrike patterns have been described. Therefore, this narrative review summarizes the existing classifications of footstrike patterns, gives suggestions for further use of these classifications, and provides a summary of the relationship between footstrike patterns and the occurrence of overuse injuries. Footstrike patterns are classified by using nominal (e.g. forefoot strike, midfoot strike, rearfoot strike) or continuous variables (e.g. footstrike angle). Possible assessments include visual, video-based, 3D-biomechanical, force plate-based or inertial measurement unit-based analysis. Scientists, coaches, and clinicianscan choose between different methods to analyze footstrike patterns in runners. All approaches to classify footstrike patterns have advantages and limitations. In certain situations, it might be beneficial to combine these methods. Despite great efforts in analyzing footstrike patterns, relationships between footstrike patterns and running-related injuries are mostly unclear at present. Based on the current literature, causal links to overuse injuries, recommendations to change running technique, and other simplifications solely based on the footstrike pattern must be considered critically. KEY WORDS: Running, Biomechanics, Overuse Injuries

Problem: Awareness and knowledge of the Female Athlete Triad (Triad) among physicians and allied health professionals is well studied; however, awareness of Relative Energy Deficiency in Sport (RED-S) is largely unknown. The purpose of this study is to assess awareness and comfort in treating patients with Triad and RED-S among providers attending a sports medicine conference.Methods: Cross-sectional study of physicians and allied health professionals attending a sports medicine conference. Conference attendees (n=163, 54% female) completed a survey on awareness of and confidence in treating Triad and RED-S (response rate=42%). Results: Most participants (76%) were aware of Triad compared to fewer with awareness regarding RED-S (29%). More participants (33%) reported feeling comfortable treating athletes with the Triad compared to RED-S (13%) (p

Copyright of German Journal of Sports Medicine / Deutsche Zeitschrift fur Sportmedizin is the property of Verein zur Forderung der Sportmedizin Hannover e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of German Journal of Sports Medicine / Deutsche Zeitschrift fur Sportmedizin is the property of Verein zur Forderung der Sportmedizin Hannover e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)