This is part 3 of a 3 part series on what I’ve learned at the 2018 Rowing Sports Medicine and Science Conference. Post one was about Low Back Pain in Rowers, the second on Rib Stress Injuries and Fractures in Rowers, and this post will focus on the Para Sport with regards to safeguarding and injuries. Dr Yetsa Tuakli-Wosornu was the main speaker on this topic and these are my notes from the session:
Safeguarding athletes from intentional injury/harm
This was a very important subject at the conference. Intentional injury or harm and includes psychological, physical, and sexual abuse. A power differential anchors every form of harassment and abuse in sport. Everybody on the athlete support team, including the medical professionals, should form part of the safeguarding process.
Safeguarding and para athletes:
- Athletes with impairments have up to 4 times higher risk of harassment and abuse in sport compared to able-bodied athletes
- The risk is increased when an athlete needs assistance with daily self-care activities, this includes communication, travel and logistics
- Disability is a predictor in all forms of abuse
- Risk factors and effectiveness of current prevention strategies are still unknown
- Cyberbullying is common in athletes with a disability and tolerated for social inclusion/friendship according to this article: McHugh MC, Howard DE. Friendship at Any Cost: Parent Perspectives on Cyberbullying Children With Intellectual and Developmental Disabilities. Journal of Mental Health Research in Intellectual Disabilities. 2017 Oct 2;10(4):288-308.
Read more about Safeguarding
Injuries in Paralympic athletes
Epidemiology of injuries in para athletes
- Athletes using wheelchairs are more prone to upper extremity injuries
- Ambulant athletes are generally more prone to lower extremity injuries
- Male and females generally have the same overall injury rates
- Chronic overuse injuries are more common than acute traumatic injuries
- Injury rates may be reduced by mandatory periodic health evaluations
- Very limited data exist on overuse injuries in para rowers. 2 para rowing specific journal articles are available:
- Tiller NB, Aggar TR, West CR, Romer LM. Exercise-induced diaphragm fatigue in a Paralympic champion rower with spinal cord injury. Journal of Applied Physiology. 2017 Nov 30;124(3):805-11.
- Smoljanović T, Bojanić I, Pollock CL, Radonić R. Rib stress fracture in a male adaptive rower from the arms and shoulders sport class: case report. Croatian medical journal. 2011 Oct 15;52(5):644-7.
Risk factors for shoulder injuries in para athletes (recreational to elite)
- Increased age
- Spinal cord injury
- Imbalance in the shoulder muscles
- Highest injury rate at the summer paralympic games was in Football 5-a-side and at the winter games in skiing and snowboarding
- Seated athletes:
- The shoulder becomes a weight-bearing joint leading to a high risk of overuse injuries
- Most sports are also upper extremity dominant
- Daily wheelchair users also use the upper extremities for mobility, transfers and pressure relief
- Influence decision making regarding treatment and diagnostics as the athlete needs to use the upper extremity
- Pre- rehabilitation exercises
- Pre-participation physical exam with a focus on looking for imbalances in the shoulder girdle muscles including a PPE ultrasound in high-risk Para-athletes
- It is important to consider the demographics of para athletes in injury prevention because the average age of para athletes is 45
- Equipment regulation might be important in preventing injuries
Resources on shoulder injury prevention and treatment:
- This study evaluated a 6-week intervention including strengthening and stretching and found that this intervention may decrease risk factors for shoulder injury in wheelchair basketball athletes. The participants did a 5-minute injury prevention program 3 times a week for 6 weeks. Other studies have shown that improving range of motion is linked to a decrease in shoulder pain an injury because of better scapula kinematics.
Wilroy J, Hibberd E. Evaluation of a shoulder injury prevention program in wheelchair basketball. Journal of sport rehabilitation. 2017:1-21.
- This study explored an 8-week exercise program that consisted of stretching and strengthening the muscles around the scapula to determine the effect on people with spinal cord injuries with shoulder impingement symptoms. Stretches included the following muscles: upper trapezius, Pectoralis, Long head of Biceps, and the posterior capsule. Strengthening exercises focussed on the following muscles: Middle and Lower Trapezius, Serratus Anterior, and Shoulder External Rotators. (See images and descriptions in the article) Nawoczenski DA, Ritter-Soronen JM, Wilson CM, Howe BA, Ludewig PM. Clinical trial of exercise for shoulder pain in chronic spinal injury. Physical therapy. 2006 Dec 1;86(12):1604-18.
- The authors in study examined a 12-week home based exercise program for people with spinal cord injuries.
Mulroy SJ, Thompson L, Kemp B, Hatchett PP, Newsam CJ, Lupold DG, Haubert LL, Eberly V, Ge TT, Azen SP, Winstein CJ. Strengthening and optimal movements for painful shoulders (STOMPS) in chronic spinal cord injury: a randomized controlled trial. Physical Therapy. 2011 Mar 1;91(3):305-24.
- Van Straaten MG, Cloud BA, Morrow MM, Ludewig PM, Zhao KD. Effectiveness of home exercise on pain, function, and strength of manual wheelchair users with spinal cord injury: a high-dose shoulder program with telerehabilitation. Archives of physical medicine and rehabilitation. 2014 Oct 1;95(10):1810-7.
- Wilbanks SR, Bickel CS. Scapular stabilization and muscle strength in manual wheelchair users with spinal cord injury and subacromial impingement. Topics in spinal cord injury rehabilitation. 2016 Feb 17;22(1):60-70.
Resources on Injuries and Illness in Para Sport
- Willick SE, Webborn N, Emery C, Blauwet CA, Pit-Grosheide P, Stomphorst J, Van de Vliet P, Marques NA, Martinez-Ferrer JO, Jordaan E, Derman W. The epidemiology of injuries at the London 2012 Paralympic Games. Br J Sports Med. 2013 Mar 19:bjsports-2013.
- Derman W, Schwellnus M, Jordaan E, Blauwet CA, Emery C, Pit-Grosheide P, Marques NA, Martinez-Ferrer O, Stomphorst J, Van de Vliet P, Webborn N. Illness and injury in athletes during the competition period at the London 2012 Paralympic Games: development and implementation of a web-based surveillance system (WEB-IISS) for team medical staff. Br J Sports Med. 2013 May 1;47(7):420-5.
- Schwellnus M, Derman W, Jordaan E, Blauwet CA, Emery C, Pit-Grosheide P, Marques NA, Martinez-Ferrer O, Stomphorst J, Van de Vliet P, Webborn N. Factors associated with illness in athletes participating in the London 2012 Paralympic Games: a prospective cohort study involving 49 910 athlete-days. Br J Sports Med. 2013 May 1;47(7):433-40.
- Derman W, Schwellnus M, Jordaan E. Clinical characteristics of 385 illnesses of athletes with impairment reported on the WEB-IISS system during the London 2012 Paralympic Games. PM&R. 2014 Aug 1;6(8):S23-30.
- Webborn N, Van de Vliet P. Paralympic Medicine. The Lancet. 2012 Jul 7;380(9836):65-71.