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Sports Medicine Considerations for the Paralympic Athlete

  • Sports Medicine Rehabilitation (SA Herring and L Concannon, Section Editors)
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Abstract

Increased participation and expanded public interest in the Paralympic Games underline the growing importance of competitive sports opportunities for individuals with disabilities. Injury surveillance is increasingly recognized as a key element of sports medicine research, and recent work has suggested that rates of injury, anatomic location of injury, and associated illness may in fact differ in athletes with disabilities. A greater understanding of the patterns of injury and illness for athletes with disabilities has important clinical implications for rehabilitation and sports medicine physicians. This review summarizes commonly observed musculoskeletal injuries that affect athletes with disabilities, including athletes using sports wheelchairs for competition, athletes with amputations, athletes with cerebral palsy, and athletes with visual impairment. Medical issues that may affect athletes with disabilities include autonomic dysreflexia, complications of neurogenic bowel and bladder, impaired thermoregulation, and skin breakdown. As a growing number of athletes with disabilities participate in sports activities, physicians must develop an increased understanding and expertise in treating and preventing injuries in these athletes.

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References

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  1. Gold JR, Gold MM. Access for all: the rise of the Paralympic Games. J R Soc Promot Health. 2007;127(3):133–41.

    PubMed  Google Scholar 

  2. Willick SE, Lexell J. Paralympic sports medicine and sports science-introduction. PM R. 2014;6(8 Suppl):S1–3.

    PubMed  Google Scholar 

  3. • Webborn N, Emery C. Descriptive epidemiology of paralympic sports injuries. PM R. 2014;6(8 Suppl):S18–22. This reference provides a review of contemporary and early studies of sports injuries in paralympic athletes. The authors touch upon methodologic limitations of prior analyses and emerging trends in current research that highlight the need for longitudinal research to inform sports policies and injury prevention.

    Google Scholar 

  4. • Tweedy SM, Beckman EM, Connick MJ. Paralympic classification: conceptual basis, current methods, and research update. PM R. 2014;6(8 Suppl):S11–7. Tweedy and colleagues review the theoretical basis for sports classification systems and their role in promoting competition in Paralympic sports by athletes with disabilities in this research update. The reference also includes a practical description of the classification process and eligible impairment types by sport activity. The development and reporting of valid measures of impairment are noted as essential for evidence-based classification methods.

    Google Scholar 

  5. • Tweedy SM, Vanlandewijck YC. International Paralympic Committee position stand–background and scientific principles of classification in Paralympic sport. Br J Sports Med. 2011;45(4):259–69. This reference is the position stand by the International Paralympic Committee (IPC) on classification of athletes in Paralympic sport. It reviews the rationale and methodology of selective classification methods currently in use for Paralympic sports and contrasts these with classification methods that use health and functioning or sports performance as the basis of classification. It finishes by summarizing research priorities in the field of sports classification for Paralympic athletes.

    PubMed  Google Scholar 

  6. Reynolds J, Stirk A, Thomas A, Geary F. Paralympics-Barcelona 1992. Br J Sports Med. 1994;28(1):14–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Bloomquist LE. Injuries to athletes with physical disabilities: prevention implications. Phys Sports Med. 1986;14(9):97–105.

    Google Scholar 

  8. Ferrara MS, Buckley WE, Mccann BC, Limbird TJ, Powell JW, Robl R. The injury experience of the competitive athlete with a disability: prevention implications. Med Sci Sports Exerc. 1992;24(2):184–8.

    CAS  PubMed  Google Scholar 

  9. Webborn N, Willick S, Reeser JC. Injuries among disabled athletes during the 2002 Winter Paralympic Games. Med Sci Sports Exerc. 2006;38(5):811–5.

    PubMed  Google Scholar 

  10. • Webborn N, Willick S, Emery CA. The injury experience at the 2010 winter paralympic games. Clin J Sport Med. 2012;22(1):3–9. This reference is a descriptive study that highlighted the varying rates of injury for the three winter Paralympic sports, alpine skiing, downhill racing, and ice sledge hockey. The authors demonstrate a reduced percentage of fractures for ice sledge hockey players after modifications in regulations on protective equipment worn by athletes and sledge height compared with injury rates at the 2002 and 2006 winter Paralympic games.

  11. • Webborn N, Van de vliet P. Paralympic medicine. Lancet. 2012;380(9836):65–71. This reference defines the field of Paralympic medicine as health-related issues related to Paralympic athletes and reviews the epidemiology of medical issues within specific disability categories for athletes.

    Google Scholar 

  12. Willick SE, Webborn N, Emery C, et al. The epidemiology of injuries at the London 2012 Paralympic Games. Br J Sports Med. 2013;47(7):426–32.

    PubMed  Google Scholar 

  13. • Schwellnus M, Derman W, Jordaan E, et al. 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;47(7):433–40. This reference details a cohort study of athletes in the 2012 summer Paralympic games using team medical support and a novel web-based surveillance system to capture information on illness in athletes. The authors demonstrate a high incidence of illness in Paralympic athletes affecting the respiratory, skin, digestive, nervous, and genitourinary systems and a similar incidence of injury for precompetition and competition periods. The incidence of illness was also shown to vary by sport.

    PubMed  Google Scholar 

  14. • Cooper RA, De luigi AJ. Adaptive sports technology and biomechanics: wheelchairs. PM R. 2014;6(8 Suppl):S31–9. The authors review adaptive technology, specifically wheeled technology, for Paralympic sports activities. This reference includes an overview of different types of wheelchair design by sport, manufacturing and materials, as well as propulsion and seating biomechanics.

    Google Scholar 

  15. Goosey-tolfrey V. Supporting the paralympic athlete: focus on wheeled sports. Disabil Rehabil. 2010;32(26):2237–43.

    PubMed  Google Scholar 

  16. Vanlandewijck YC, Verellen J, Tweedy S. Towards evidence-based classification in wheelchair sports: impact of seating position on wheelchair acceleration. J Sports Sci. 2011;29(10):1089–96.

    PubMed  Google Scholar 

  17. • Mason BS, Van der woude LH, Goosey-tolfrey VL. The ergonomics of wheelchair configuration for optimal performance in the wheelchair court sports. Sports Med. 2013;43(1):23–38. This reference offers an exhaustive review of biomechanical factors related to wheelchair configuration that have been shown to affect propulsion and maneuverability and may affect sports performance in the wheelchair “court sports” of wheelchair rugby, wheelchair tennis, and wheelchair basketball. It discusses the current literature related to research in non-athlete populations as well as sports performance.

    Google Scholar 

  18. Rice R, Hettinga FJ, Laferrier J, Sporner ML, Heiner CM, Burkett B, Cooper RA. Chapter 2: Biomechanics. In: Vanlandewijck YC, Thompson WR editors. Handbook of sports medicine and science, the paralympic athlete. Oxford: Wiley-Blackwell; 2011.

    Google Scholar 

  19. Croft L, Dybrus S, Lenton J, Goosey-tolfrey V. A comparison of the physiological demands of wheelchair basketball and wheelchair tennis. Int J Sports Physiol Perform. 2010;5(3):301–15.

    PubMed  Google Scholar 

  20. International Tennis Federation. ITF Regulations for Wheelchair Tennis 2014. International Tennis Federation. 2014. http://www.itftennis.com/media/166656/166656.pdf. Accessed 11 Oct 2014.

  21. Ferrara MS, Peterson CL. Injuries to athletes with disabilities: identifying injury patterns. Sports Med. 2000;30(2):137–43.

    CAS  PubMed  Google Scholar 

  22. Klenck C, Gebke K. Practical management: common medical problems in disabled athletes. Clin J Sport Med. 2007;17(1):55–60.

    PubMed  Google Scholar 

  23. Dec KL, Sparrow KJ, Mckeag DB. The physically-challenged athlete: medical issues and assessment. Sports Med. 2000;29(4):245–58.

    CAS  PubMed  Google Scholar 

  24. Yildirim NU, Comert E, Ozengin N. Shoulder pain: a comparison of wheelchair basketball players with trunk control and without trunk control. J Back Musculoskelet Rehabil. 2010;23(2):55–61.

    PubMed  Google Scholar 

  25. Halpern BC, Boehm R, Cardone DA. The disabled athlete. In: Garrett WE, Kirkendall DR, Squire DL, editors. Principles and Practice of Primary Sports Care Medicine. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 115–29.

    Google Scholar 

  26. Boninger ML, Robertson RN, Wolff M, Cooper RA. Upper limb nerve entrapments in elite wheelchair racers. Am J Phys Med Rehabil. 1996;75(3):170–6.

    CAS  PubMed  Google Scholar 

  27. Boninger ML, Impink BG, Cooper RA, Koontz AM. Relation between median and ulnar nerve function and wrist kinematics during wheelchair propulsion. Arch Phys Med Rehabil. 2004;85(7):1141–5.

    PubMed  Google Scholar 

  28. Boninger ML, Koontz AM, Sisto SA, et al. Pushrim biomechanics and injury prevention in spinal cord injury: recommendations based on CULP-SCI investigations. J Rehabil Res Dev. 2005;42(3 Suppl 1):9–19.

    PubMed  Google Scholar 

  29. Nolan L. Carbon fibre prostheses and running in amputees: a review. Foot Ankle Surg. 2008;14(3):125–9.

    PubMed  Google Scholar 

  30. • Willick S, Webborn N. Chapter 4: Medicine. In: Vanlandewijck YC, Thompson WR editors. Handbook of sports medicine and science, the paralympic athlete. Oxford: Wiley-Blackwell; 2011. This handbook is a key resource on Paralympic medicine. The authors review medical conditions specific to athletes with a disability, sports epidemiology, clinical evaluation, and travel considerations for athletes in this chapter.

    Google Scholar 

  31. Kegel B, Malchow D. Incidence of injury in amputees playing soccer. Palaestra. 1994;10(2):50–4.

    Google Scholar 

  32. Bernardi M, Castellano V, Ferrara MS, Sbriccoli P, Sera F, Marchetti M. Muscle pain in athletes with locomotor disability. Med Sci Sports Exerc. 2003;35(2):199–206.

    PubMed  Google Scholar 

  33. Melzer I, Yekutiel M, Sukenik S. Comparative study of osteoarthritis of the contralateral knee joint of male amputees who do and do not play volleyball. J Rheumatol. 2001;28(1):169–72.

    CAS  PubMed  Google Scholar 

  34. Cerebral Palsy-International Sport and Recreation Association. CPISRA Sports Manual 10th Edition (2009–2011). Cerebral Palsy-International Sport and Recreation Association. 2011. http://cpisra.org/main/wp-content/uploads/2013/06/CPISRA-Classification-Rules-Release-9-October-27-2010.pdf. Accessed 11 Oct 2011.

  35. Hutzler Y, Meckel Y, Berzen J. Chapter 8: Aerobic and anaerobic power. In: Vanlandewijck YC, Thompson WR editors. Handbook of sports medicine and science, the paralympic athlete. Oxford: Wiley-Blackwell; 2011.

  36. Stackhouse SK, Binder-macleod SA, Lee SC. Voluntary muscle activation, contractile properties, and fatigability in children with and without cerebral palsy. Muscle Nerve. 2005;31(5):594–601.

    PubMed  PubMed Central  Google Scholar 

  37. Runciman P, Derman W, Ferreira S, Albertus-kajee Y, Tucker R. A descriptive comparison of sprint cycling performance and neuromuscular characteristics in able-bodied athletes and paralympic athletes with cerebral palsy. Am J Phys Med Rehabil. 2015;94(1):28–37.

    Google Scholar 

  38. Novak I, Mcintyre S, Morgan C, et al. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol. 2013;55(10):885–910.

    PubMed  Google Scholar 

  39. Autti-rämö I, Larsen A, Taimo A. Von wendt L. Management of the upper limb with botulinum toxin type A in children with spastic type cerebral palsy and acquired brain injury: clinical implications. Eur J Neurol. 2001;8(Suppl 5):136–44.

    PubMed  Google Scholar 

  40. Verschuren O, Bloemen M, Kruitwagen C, Takken T. Reference values for anaerobic performance and agility in ambulatory children and adolescents with cerebral palsy. Dev Med Child Neurol. 2010;52(10):e222–8.

    PubMed  Google Scholar 

  41. Reid S, Hamer P, Alderson J, Lloyd D. Neuromuscular adaptations to eccentric strength training in children and adolescents with cerebral palsy. Dev Med Child Neurol. 2010;52(4):358–63.

    PubMed  Google Scholar 

  42. United States Association of Blind Athletes. Sports Adaptations. United States Association of Blind Athletes. 2014. http://usaba.org/index.php/sports/sports-adaptations/. Accessed 14 Oct 2014.

  43. IBSA (International Blind Sports Federation) Football Subcommittee. IBSA Football Rulebook 2014-2017. International Blind Sports Federation. 2014. http://www.ibsasport.org/sports/files/309-Rules-IBSA-Blind-Football-Rules-2014-2017.pdf. Accessed 14 Oct 2014.

  44. Magno e silva MP, Winckler C, Costa e silva AA, Bilzon J, Duarte E. Sports injuries in paralympic track and field athletes with visual impairment. Med Sci Sports Exerc. 2013;45(5):908–13.

    PubMed  Google Scholar 

  45. Magno e Silva MP, Morato MP, Bilzon JL, Duarte E. Sports injuries in Brazilian blind footballers. Int J Sports Med. 2013;34(3):239–43.

    PubMed  Google Scholar 

  46. • Magno e silva M, Bilzon J, Duarte E, Gorla J, Vital R. Sport injuries in elite paralympic swimmers with visual impairment. J Athl Train. 2013;48(4):493–8. The findings from this study that elite Paralympic swimmers with visual impairment had an increased prevalence of overuse injuries compared with traumatic injuries and that athletes’ trunks, upper limbs, and shoulders were the most commonly involved suggests that sports-specific activities and training loads contribute to injury profiles for visually impaired athletes.

    PubMed Central  Google Scholar 

  47. Krassioukov A. Autonomic dysreflexia: current evidence related to unstable arterial blood pressure control among athletes with spinal cord injury. Clin J Sport Med. 2012;22(1):39–45.

    PubMed  Google Scholar 

  48. Krassioukov A, Warburton DE, Teasell R, Eng JJ. A systematic review of the management of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehabil. 2009;90(4):682–95.

    PubMed  PubMed Central  Google Scholar 

  49. West CR, Wong SC, Krassioukov AV. Autonomic cardiovascular control in Paralympic athletes with spinal cord injury. Med Sci Sports Exerc. 2014;46(1):60–8.

    PubMed  Google Scholar 

  50. • Blauwet CA, Benjamin-laing H, Stomphorst J, Van de vliet P, Pit-grosheide P, Willick SE. Testing for boosting at the Paralympic games: policies, results and future directions. Br J Sports Med. 2013;47(13):832–7. This reference details the protocol and process of creating and implementing a screening protocol for boosting, or intentionally induced autonomic dysreflexia, at the Paralympic games.

    PubMed  Google Scholar 

  51. Schmid A, Schmidt-trucksäss A, Huonker M, et al. Catecholamines response of high performance wheelchair athletes at rest and during exercise with autonomic dysreflexia. Int J Sports Med. 2001;22(1):2–7.

    CAS  PubMed  Google Scholar 

  52. Bhambhani Y, Mactavish J, Warren S, et al. Boosting in athletes with high-level spinal cord injury: knowledge, incidence and attitudes of athletes in paralympic sport. Disabil Rehabil. 2010;32(26):2172–90.

    PubMed  Google Scholar 

  53. • Krassioukov A, West C. The role of autonomic function on sport performance in athletes with spinal cord injury. PM R. 2014;6(8 Suppl):S58–65. A comprehensive review of the pathophysiology of autonomic dysreflexia in spinal cord injury and the affect of autonomic dysfunction on sports performance, including the possible use of intentionally induced autonomic dysreflexia (AD) for performance enhancement and associated health risks for athletes.

    Google Scholar 

  54. García leoni ME, de Esclarín ruz A. Management of urinary tract infection in patients with spinal cord injuries. Clin Microbiol Infect. 2003;9(8):780–5.

    PubMed  Google Scholar 

  55. Price MJ, Campbell IG. Effects of spinal cord lesion level upon thermoregulation during exercise in the heat. Med Sci Sports Exerc. 2003;35(7):1100–7.

    PubMed  Google Scholar 

  56. Simon LM, Ward DC. Preparing for events for physically challenged athletes. Curr Sports Med Rep. 2014;13(3):163–8.

    PubMed  Google Scholar 

  57. Hagobian TA, Jacobs KA, Kiratli BJ, Friedlander AL. Foot cooling reduces exercise-induced hyperthermia in men with spinal cord injury. Med Sci Sports Exerc. 2004;36(3):411–7.

    PubMed  Google Scholar 

  58. Webborn N, Price MJ, Castle PC, Goosey-tolfrey VL. Effects of two cooling strategies on thermoregulatory responses of tetraplegic athletes during repeated intermittent exercise in the heat. J Appl Physiol. 2005;98(6):2101–7.

    CAS  PubMed  Google Scholar 

  59. Goosey-tolfrey V, Swainson M, Boyd C, Atkinson G, Tolfrey K. The effectiveness of hand cooling at reducing exercise-induced hyperthermia and improving distance-race performance in wheelchair and able-bodied athletes. J Appl Physiol. 2008;105(1):37–43.

    PubMed  Google Scholar 

  60. Dealey C. Skin care and pressure ulcers. Adv Skin Wound Care. 2009;22(9):421–8.

    PubMed  Google Scholar 

  61. Berthold J, Dicianno BE, Cooper RA. Pressure mapping to assess seated pressure distributions and the potential risk for skin ulceration in a population of sledge hockey players and control subjects. Disabil Rehabil Assist Technol. 2013;8(5):387–91.

    PubMed  Google Scholar 

  62. Darrah SD, Dicianno BE, Berthold J, Mccoy A, Haas M, Cooper RA. Measuring static seated pressure distributions and risk for skin pressure ulceration in ice sledge hockey players. Disabil Rehabil Assist Technol. 2014;29:1–6.

  63. White S. The disabled athlete. In: Brukner P, Khan K, editors. Clinical Sports Medicine, revised. 2nd ed. Australia: McGraw-Hill; 2002. p. 705–9.

    Google Scholar 

  64. Jiang SD, Dai LY, Jiang LS. Osteoporosis after spinal cord injury. Osteoporos Int. 2006;17(2):180–92.

    PubMed  Google Scholar 

  65. Maïmoun L, Fattal C, Micallef JP, Peruchon E, Rabischong P. Bone loss in spinal cord-injured patients: from physiopathology to therapy. Spinal Cord. 2006;44(4):203–10.

    PubMed  Google Scholar 

  66. Nelson ME, Rejeski WJ, Blair SN, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1435–45.

    PubMed  Google Scholar 

  67. Blauwet CA, Iezzoni LI. From the paralympics to public health: increasing physical activity through legislative and policy initiatives. PM R. 2014;6(8 Suppl):S4–10.

    PubMed  Google Scholar 

  68. Rimmer JH, Marques AC. Physical activity for people with disabilities. Lancet. 2012;380(9838):193–5.

    PubMed  Google Scholar 

  69. Tweedy S, Howe PD. Chapter 1: Introduction to the paralympic movement. In: Vanlandewijck YC, Thompson WR editors. Handbook of sports medicine and science, the paralympic thlete. Oxford: Wiley-Blackwell; 2011.

    Google Scholar 

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Authors and Affiliations

  1. Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA, 02129, USA

    Chloe Slocum

  2. Harvard Medical School, Brigham and Women’s Hospital Orthopedic Sports Medicine Service, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA, 02129, USA

    Cheri A. Blauwet

  3. Allen Spine and Sports Medicine PC, UNC-Wilmington Sports Medicine, 1721 Allens Lane, Wilmington, NC, 28480, USA

    Joanne B. Anne Allen

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  1. Chloe Slocum
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  2. Cheri A. Blauwet
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  3. Joanne B. Anne Allen
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Correspondence to Joanne B. Anne Allen.

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Slocum, C., Blauwet, C.A. & Anne Allen, J.B. Sports Medicine Considerations for the Paralympic Athlete. Curr Phys Med Rehabil Rep 3, 25–35 (2015). https://doi.org/10.1007/s40141-014-0074-x

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