Background Current methods for injury registration in sports injury epidemiology studies may substantially underestimate the true burden of overuse injuries due to a reliance on time-loss injury definitions. Objective To develop and validate a new method for the registration of overuse injuries in sports. Methods A new method, including a new overuse injury questionnaire, was developed and validated in a 13-week prospective study of injuries among 313 athletes from five different sports, cross-country skiing, floorball, handball, road cycling and volleyball. All athletes completed a questionnaire by email each week to register problems in the knee, lower back and shoulder. Standard injury registration methods were also used to record all time-loss injuries that occurred during the study period. Results The new method recorded 419 overuse problems in the knee, lower back and shoulder during the 3-month-study period. Of these, 142 were classified as substantial overuse problems, defined as those leading to moderate or severe reductions in sports performance or participation, or time loss. Each week, an average of 39% of athletes reported having overuse problems and 13% reported having substantial problems. In contrast, standard methods of injury registration registered only 40 overuse injuries located in the same anatomical areas, the majority of which were of minimal or mild severity. Conclusion Standard injury surveillance methods only capture a small percentage of the overuse problems affecting the athletes, largely because few problems led to time loss from training or competition. The new method captured a more complete and nuanced picture of the burden of overuse injuries in this cohort.

Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport-specific or setting-specific consensus statements on sports injury (and, eventually, illness) epidemiology to date. Our objective was to further strengthen consistency in data collection, injury definitions and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups and a 3-day consensus meeting in October 2019. This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems; severity of health problems; capturing and reporting athlete exposure; expressing risk; burden of health problems; study population characteristics and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE Extension-the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). The IOC encourages ongoing in-and out-ofcompetition surveillance programmes and studies to describe injury and illness trends and patterns, understand their causes and develop measures to protect the health of the athlete. Implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.

Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk management. Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way. The purpose of this consensus statement was to present and synthesise current evidence to make recommendations for return to sport decision-making, clinical practice and future research directions related to returning athletes to sport. A half day meeting was held in Bern, Switzerland, after the First World Congress in Sports Physical Therapy. 17 expert clinicians participated. 4 main sections were initially agreed upon, then participants elected to join 1 of the 4 groups-each group focused on 1 section of the consensus statement. Participants in each group discussed and summarised the key issues for their section before the 17-member group met again for discussion to reach consensus on the content of the 4 sections. Return to sport is not a decision taken in isolation at the end of the recovery and rehabilitation process. Instead, return to sport should be viewed as a continuum, paralleled with recovery and rehabilitation. Biopsychosocial models may help the clinician make sense of individual factors that may influence the athlete's return to sport, and the Strategic Assessment of Risk and Risk Tolerance framework may help decision-makers synthesise information to make an optimal return to sport decision. Research evidence to support return to sport decisions in clinical practice is scarce. Future research should focus on a standardised approach to defining, measuring and reporting return to sport outcomes, and identifying valuable prognostic factors for returning to sport

The new method was sensitive and valid in documenting the pattern of acute injuries, overuse injuries and illnesses in a large, heterogeneous group of athletes preparing for the Olympic and Paralympic Games.

Injury prevention programmes should incorporate interventions aimed at improving glenohumeral rotational range of motion, external rotation strength and scapular control.

Dette er siste tekst-versjon av artikkelen, og den kan inneholde små forskjeller fra forlagets pdf-versjon. Forlagets pdf-versjon finner du på bjsm.bmj.com: http://dx.doi. org/10.1136/bjsports-2016-096226 This is the final text version of the article, and it may contain minor differences from the journal's pdf version. Design Stratified cluster-randomised controlled trial with teams as the unit of randomisation.Setting 45 handball teams (22 female, 23 male) from the two upper divisions in Norway (22 in the intervention group, 23 in the control group) were followed for one competitive season (7 months).Participants 660 players aged 16-47 (331 in the intervention group, 329 in the control group).Intervention Ten-minute comprehensive exercise program to increase glenohumeral internal rotation, external rotation strength and scapular control, as well as improve kinetic chain and thoracic mobility, to be delivered by coaches and team captains three times per week as a part of the handball warm-up throughout the season. Main outcome measuresPrevalence of shoulder problems and substantial shoulder problems. ResultsThe average prevalence of shoulder problems during the season was 17% (95% CI: 16% to 19%) in the intervention group and 23% (95% CI: 21% to 26%) in the control group (mean difference: 6%). The average prevalence of substantial shoulder problems was 5% (95% CI: 4% to 6%) in the intervention group and 8% (95% CI: 7% to 9%) in the control group (mean difference: 3%). Using generalized estimating equation models, a 28% lower risk of shoulder problems (OR 0.72, 95% CI: 0.52 to 0.98, p=0.038) and 22% lower risk of substantial shoulder problems (OR 0.78, 95% CI: 0.53 to 1.16, p=0.23) was observed in the intervention group compared to the control group.Conclusion A comprehensive exercise program reduced the prevalence of shoulder problems in elite handball.

No abstract

Little is known about the true extent and severity of overuse injuries in sport, largely because of methodological challenges involved in recording them. This study assessed the prevalence of overuse injuries among Norwegian athletes from five sports using a newly developed method designed specifically for this purpose. The Oslo Sports Trauma Research Center Overuse Injury Questionnaire was distributed weekly by e-mail to 45 cross-country skiers, 98 cyclists, 50 floorball players, 55 handball players, and 65 volleyball players for 13 weeks. The prevalence of overuse problems at the shoulder, lower back, knee, and anterior thigh was monitored throughout the study and summary measures of an injury severity score derived from athletes' questionnaire responses were used to gauge the relative impact of overuse problems in each area. The area where overuse injuries had the greatest impact was the knee in volleyball where, on average, 36% of players had some form of complaint (95% CI 32-39%). Other prevalent areas included the shoulder in handball (22%, 95% CI 16-27%) the knee in cycling (23%, 95% CI 17-28%), and the knee and lower back in floorball (27%, 95% CI 24-31% and 29%, 95% CI 25-33%, respectively).