ECSS Paris 2023: OP-MH31
INTRODUCTION: Bone Stress Injuries (BSIs) are one of the main health problems among elite athletes causing loss of a large number of training days and even the end of the competition season. BSI occur as a result of an imbalance between the mechanical load placed on the bone that leads to abnormal remodelling. Numerous risk factors have been postulated for their development, including training load, type of sport, individual anatomical and biomechanical characteristics, nutritional status, and general health factors. Identifying such determinants could enable the creation of effective screening tools and targeted preventive programs to reduce injury risk among athletes. The aim of the study was to provide information about the prevalence, and selected characteristics associated with BSIs among professional Polish athletes. METHODS: The study included elite Polish athletes representing Olympic sport disciplines who completed a questionnaire during routine medical examinations regarding lifetime history of BSIs and training-related factors. RESULTS: 64 of 956 active athletes (6,7%) reported BSI in their medical history. The prevalence of BSI was higher in women than in men and differed significantly across sport categories, with the highest proportion among endurance athletes. Within the BSI group, 76.6% of athletes reported a subjective relationship between the occurrence of the injury and a significant change in their training regimen. The most frequently mentioned training-related changes included increased intensity (43.8%) and training volume (21.9%), as well as early sport specialization (51.6%). CONCLUSION: The number of BSI reported in our group is comparable with the results of other studies which range from 4-5% annually among runners to 8.3%-52% in endurance runners and track and field athletes. The main findings of our study indicate significant associations between incidence of BSI and sex (female athletes), as well as the type of training, with a higher prevalence observed in endurance sports. Factors that have been proposed to explain higher incidence of BSIs among female athletes can be divided into two categories - those related to the constitutional structure of the female body and those related to behaviours that influence the hormonal balance. It appears that the specific nature of endurance sports appears to have a substantial influence on disrupting bone remodelling. Early specialization was significantly more prevalent in athletes with a history of BSI in mixed sports compared with endurance sports. A plausible explanation is that mixed training - combining high load in terms of volume and intensity - can cause excessive loading that disrupts bone remodelling in the developing skeletal system. Conclusion: BSIs represent a relevant health issue among professional athletes, particularly among women and endurance athletes. Early specialization and increases in training volume were commonly reported characteristics among athletes with a history of BSI.
Read CV Jaroslaw KrzywanskiECSS Paris 2023: OP-MH31
INTRODUCTION: Vitamin D deficiency is common in athletic populations and has been implicated in musculoskeletal health. While its role in bone injury is well known, the association between vitamin D deficiency and soft-tissue injury remains unclear. This study aimed to systematically review and meta-analyse the association between vitamin D deficiency and the prevalence of soft-tissue injuries in athletes. METHODS: A systematic review was conducted in MEDLINE (OVID) and the Cochrane Library using predefined search terms related to vitamin D, athletes, and musculoskeletal injury. Observational studies comparing the prevalence of soft-tissue injuries between vitamin D-deficient and vitamin D-sufficient athletes were included. Study quality was assessed using the Newcastle–Ottawa Scale. A random-effects meta-analysis was performed using inverse-variance weighting with DerSimonian–Laird estimation to calculate pooled odds ratios (ORs) in the SPSS program. Statistical heterogeneity was assessed using the I-squared and tau-squared statistics. Publication bias was evaluated through funnel plot inspection and Egger’s, Harbord’s, and Peters’ regression tests. RESULTS: Six studies met the inclusion criteria and were included in the meta-analysis. Vitamin D deficiency (serum 25-hydroxyvitamin D <30 ng/ml) was not significantly associated with the prevalence of soft-tissue injury when compared with vitamin D sufficiency (pooled OR = 2.63, 95% CI 0.38–18.01; p = 0.32). Substantial heterogeneity was observed across studies (I squared = 93%; tau squared = 2.63). Although most included studies reported effect estimates suggestive of increased injury prevalence among vitamin D-deficient athletes, confidence intervals were wide and inconsistent. No evidence of publication bias was identified on visual inspection or through regression-based testing. CONCLUSION: This meta-analysis found no statistically significant association between vitamin D deficiency and the prevalence of soft-tissue injuries in athletes. Despite a tendency toward higher injury prevalence in vitamin D-deficient groups within individual studies, the pooled findings were inconclusive and characterised by marked heterogeneity. These results conflict with aspects of the existing literature suggesting a potential relationship between low vitamin D status and musculoskeletal injury risk. The current evidence base remains limited and inconsistent, underscoring the need for larger, well-designed prospective studies to more definitively clarify the role of vitamin D status in soft-tissue injury risk among athletic populations.
Read CV Srisiddharth YadatiECSS Paris 2023: OP-MH31
INTRODUCTION: There is a growing body of evidence suggesting that inherited DNA sequence variants are important intrinsic risk factors that predispose individuals to musculoskeletal injuries. Previous studies have investigated associations between types I, V, VI, XI and XII collagen gene variants and lower-limb tendinopathies and other exercise-associated musculoskeletal phenotypes. These genes encode important structural components of tendons and other connective tissues and have been proposed to influence inter-individual variation in the biomechanical properties of these tissues and, by implication, susceptibility to injury. However, the association of these collagen gene variants with rotator cuff tendinopathy (RCT), and more specifically supraspinatus tendinopathy (SST), has not been extensively investigated. The aim of this study was therefore to investigate the independent associations, as well as hypothesis-driven collagen gene-gene interactions, of COL1A1, COL5A1, COL6A1, COL11A1, COL11A2 and COL12A1 gene variants with RCT in a South African cohort of swimmers, using a case-control genetic association study design. METHODS: One hundred and three swimmers (49 females, 54 males) with clinically diagnosed rotator cuff tendinopathy (RCT group) were recruited, of whom 84.5% (n = 87) were diagnosed with supraspinatus tendinopathy (SST subgroup). In addition, 101 apparently healthy swimmers (55 females, 46 males) with no previous history of shoulder pathology (including RCT, trauma, bursitis, or adhesive capsulitis) were recruited as controls (CON group). All participants were unrelated and of self-reported European ancestry. Participants were genotyped for the following collagen gene polymorphisms: COL1A1 rs1800012 (G>T); COL5A1 rs12722 (T>C) and rs10628678 (AGGG>-); COL6A1 rs35796750 (T>C); COL11A1 rs3753841 (T>C) and rs1676486 (C>T); COL11A2 rs1799907 (A>T); and COL12A1 rs970547 (G>A). RESULTS: None of the investigated collagen gene variants were independently associated with rotator cuff tendinopathy or supraspinatus tendinopathy. The inferred C-A-(-) haplotype constructed from COL11A1 rs3753841 (T>C), COL11A2 rs1799907 (A>T) and COL5A1 rs10628678 (AGGG>–) was significantly (p = 0.034) under-represented in the SST subgroup (0.4%) compared with the control group (6.0%). However, none of the other inferred haplotypes constructed from (i) the two COL5A1 variants, (ii) the two COL11A1 variants, (iii) the combined COL11A1 and COL11A2 variants, or (iv) all COL11A1, COL11A2 and COL5A1 variants were associated with RCT or SST risk. Similarly, inferred haplotypes constructed from (i) COL5A1 and COL6A1, (ii) COL5A1 and COL12A1, and (iii) COL6A1 and COL12A1 were also not associated with RCT or SST. CONCLUSION: Although several collagen gene variants have previously been associated with lower-limb tendinopathies and other exercise-associated musculoskeletal phenotypes, none of the investigated variants were independently associated with modulating the risk of rotator cuff tendinopathy or supraspinatus tendinopathy in this cohort. Only one collagen gene–gene interaction, specifically involving allelic interactions between COL11A1, COL11A2 and COL5A1, was associated with supraspinatus tendinopathy. Future studies should further investigate the potential interaction between the functionally related types V and type XI collagen genes in the aetiology of supraspinatus tendinopathy.
Read CV Malcolm CollinsECSS Paris 2023: OP-MH31