Hanna Lindblom

Background: Olympic athletes experience a high burden of health problems, and health surveillance is fundamental for understanding and preventing injuries, illnesses, and pain. Most surveillance data on Olympic athletes have focused on the Olympic Games, with limited data on injury, illness, and pain patterns outside the Games period. Objectives: The primary aim of this study was to describe the prevalence, incidence, burden, and patterns of injury and illness, and pain prevalence, among Swedish Olympic athletes over three consecutive years. Methods: We conducted prospective weekly health surveillance (April 2022–March 2025) of 225 elite Olympic athletes (51% males; median age 25 years). Health problems were reported using the Oslo Sports Trauma Research Center Questionnaire on Health Problems and diagnosed by the athletes' medical staff. Results: A total of 1441 new health problems were reported (517 injuries, 924 illnesses), with a weekly prevalence of 23.6% (injuries 15.0%; illnesses 9.1%) and an incidence of 4.6 health problems/athlete/year (injuries 1.5; illnesses 3.1). Athletes lost on average 22 training/competition days annually (injuries 8 days; illnesses 14 days). Injury prevalence was similar between sexes and competitive seasons, with the knee (16%), lumbosacral region (14%), and shoulder (10%) being most affected. Illness prevalence was higher in females than in males (11.4% vs 6.9%; prevalence rate ratio (PRR) 1.6, 95% CI 1.4–2.0) and in winter compared with summer sports (11.4% vs 7.9%; PRR 1.4, 95% CI 1.2–1.7). Respiratory illness comprised 78% of cases. Weekly pain prevalence was 44%, with 65% of pain reports occurring without a concurrent reported health problem. Conclusions: One in four Swedish Olympic athletes reported a health problem in an average week, with 4.6 new health problems and 22 time-loss days per athlete per year. Injury and illness patterns varied between subgroups, emphasising the need for targeted prevention strategies to reduce injury and illness burden in Olympic athletes.

Objectives: To study the prevalence of pain and analgesic use in amateur football players and explore sex-based and age-based differences. Methods: A prospective cohort study of 316 amateur football players (185 females, 131 males), mean age 20 years (range 15–54). Baseline data on demographics and pain history in the preceding season were collected. Players reported training/match participation, pain, analgesic use and injuries every 2 weeks over a 7-month season (April–October 2023). Results: 2439 weekly reports were analysed. Weekly pain prevalence was 40.7% (95% CI 36.4% to 45.4%) in female players and 37.2% (32.4% to 42.7%) in male players. Moderate to severe pain was more frequently reported in youth females than youth males (weekly prevalence 20.5% (15.8% to 26.8%) vs 13.1% (9.6% to 17.9%), p=0.032). Female players reported more analgesic use than male players (27.6% (23.8% to 32.1%) vs 11.2% (8.4% to 14.8%), p<0.001). Gradual-onset injuries were the predominant cause of pain (47% in females, 50% in males). Over-the-counter paracetamol (female 70%, male 61%) and non-steroidal anti-inflammatory drugs (female 67%, male 44%) were most commonly used. Analgesic use was primarily driven by non-injury-related pain in females and gradual-onset injuries in males. Conclusions: Pain was common among amateur football players, with more than one-third of players reporting pain in a given week. Female youth players reported higher prevalence of moderate to severe pain, and both female youths and female adults used more analgesics than male counterparts. These findings call for sex-specific pain strategies and educational programmes targeting pain and medication management in amateur sports.

Objective To synthesise evidence related to the dissemination and implementation (D&I) of injury prevention interventions for female, woman and/or girl (female/woman/girl) athletes. Design Scoping review. Data sources MEDLINE, APA PsycInfo, Cochrane Databases for Systematic Review, Cochrane Central Register for Controlled Trials Registry, EMBASE, CINAHL, SPORTDiscus, ERIC, ProQuest Dissertation and Theses Global. Eligibility Primary research including ≥25% female/woman/girl athletes of any age or people working with them (eg, coaches), participating in sports competition and/or performance, were eligible. Papers reporting D&I outcomes (eg, coach knowledge, adoption and maintenance) related to an injury prevention intervention and/or a factor (eg, coach beliefs) associated with D&I outcomes were included. Results 220 papers with 419 494 participants (96 790 athletes (49% female/woman/girl), 277 923 coaches (59% working with females/women/girls) and 44 781 others) across 81 sports were included. 89% of the papers were from Europe, Oceania and North America. Papers included amateur (n=175), sub-elite (n=10), elite (n=63) and Para sport (n=2) athletes. Interventions were training strategies (n=113), personal protective equipment (PPE, n=41), policy/rules/laws (n=5) or other (n=61, eg, multimodal). There were >650 D&I outcomes; adoption was the most common, followed by athlete and coach perceptions and attitudes about injury prevention. Key facilitators of D&I were previous injury experience, higher competition levels and positive perceptions and attitudes. Conclusion Most studies on D&I of injury prevention interventions for female/woman/girl athletes were descriptive and related to athletes and coaches. Engaging people across the socio-ecological system (eg, parents, health professionals and administrators) and prioritising under-represented regions, populations and D&I-focused trials may enhance D&I outcomes and ultimately reduce injury risk in female/woman/girl athletes.

Introduction Injury prevention exercise programmes with multiple components are efficacious in reducing injuries in youth and adult football. However, obtaining high adherence to the programmes over time is an unsolved challenge. Previous studies report that players lack motivation for injury prevention training and that coaches need ongoing support when using these programmes. The overall purpose of this study is to compare the added value of implementation support on the implementation and preventive efficacy of the Knee Control+programme in male and female, youth and adult amateur football teams. Methods and analysis This is a type 3 hybrid cluster-randomised controlled trial with adherence to the Knee Control+ injury prevention programme as the primary outcome and preventive efficacy as secondary outcomes. The study will take place during the 2025 football season (April/May to October/November) in Sweden, and we aim to enrol a minimum of 117 teams with players 10 years of age and older. All teams will have access to Knee Control+ via the Swedish Football Association (FA) website and are instructed to use the programme throughout the season. Teams randomised to the intervention group will receive support for implementation of Knee Control+, and the control group will receive no implementation support. This support primarily targets coaches and consists of a smorgasbord of activities and material including physical and digital workshops, leaflets, digital material and site visits to the teams. Codesign with coaches and players was employed during the design of the implementation support. Players report use of Knee Control+ and any injuries or complaints monthly, and coaches report training and use of Knee Control+ weekly, via web-based questionnaires. Adherence to Knee Control+ (primary) and preventive effects on injury incidence and prevalence (secondary) will be compared between groups. Ethics and dissemination The study was approved by the Swedish Ethical Review Authority (Dnr 2024-07394-01). Implementation support interventions that are appreciated by the players and/or coaches will be made available and free to use on the Swedish FA website after the study’s conclusion. Fitness trainers will be able to hold workshops and make site visits after the study has been completed. Trial registration number Clinicaltrials.gov (NCT06748443).

Players are the intended end-users of injury prevention exercise programmes, but their experiences using these programmes have not been studied in amateur football. This qualitative study employed focus groups to explore amateur male and female football players' experiences of injury prevention training and motivators and facilitators of continuous injury prevention training. Six focus group discussions were accomplished - three with male and three with female players - totalling 36 players. A semi-structured interview guide was used, and the transcripts were analysed using qualitative content analysis and an inductive approach. Three main categories were described: 'Injury insights: From neglect to active injury prevention strategies', 'Empowering players and coaches: Shared responsibility and perceived value of injury prevention training', and 'Making it work: Adding fun elements and organising effective injury prevention training'. Players described that they were mainly motivated to engage in injury prevention training when they were already injured. They recognised the coach as having the main responsibility for injury prevention, but acknowledged that they could support the coach in this work. According to players, programme exercises and set-up could be arranged to make training fun and feasible for use in the long-term; for instance, by including partner exercises, integrating exercises in the football training, and establishing routines early on. Based on these results, we could try to encourage player motivation through education, increased player autonomy, and by structuring prevention training to be perceived as fun.

Objective To systematically review and synthesise the incidence and characteristics of injuries and illnesses among athletes participating in the Olympic, Youth Olympic and Paralympic Games. Design Systematic review and meta-analysis. Data sources PubMed, Embase, CINAHL, Scopus and Web of Science were searched up to 2 July 2024, and Google Scholar, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform up to 12 December 2023. Eligibility criteria for selecting studies Cohort studies conducted during the Games reporting injuries and illnesses among athletes. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool for prevalence studies, and certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation framework. Results 27 articles were included (10 Olympic, 4 Youth Olympic and 13 Paralympic Games). 23 articles had low, 3 moderate and 1 high risk of bias. Certainty of evidence was high to moderate for Olympic, high to low for Youth Olympic and low for Paralympic Games. Injury incidences per 1000 athlete-days were 6.5 (95% CI 5.9 to 7.2) during Olympic, 10.5 (95% CI 9.4 to 11.8) during Youth Olympic and 14.3 (95% CI 9.9 to 20.7) during Paralympic Games. Illness incidences per 1000 athlete-days were 3.6 (95% CI 2.8 to 4.7), 6.9 (95% CI 6.1 to 7.8) and 9.7 (95% CI 6.5 to 14.4), respectively. Lower limb injuries were frequent during Olympic and Youth Olympic Games, upper limb injuries during Paralympic Games and respiratory illnesses across all Games cohorts. Conclusions Injury and illness incidences were highest in Paralympic Games, followed by Youth Olympic and Olympic Games. Incidences and patterns of injury and illness were sport and context specific, which could inform future prevention strategies. PROSPERO registration number CRD42023475334.

This study explored youth floorball players’ and coaches’ perspectives on using the injury prevention exercise programmes (IPEPs) Knee Control or Knee Control+ (Knee Control programmes) and how to overcome barriers to programme use. We used a qualitative design with eight semistructured focus group discussions, six with players, 11–17 years old (n =42) and two with coaches (n =12). Data analysis followed the principles of qualitative content analysis. Three main categories emerged: challenges related to preventive training, promoting factors and solutions to facilitate the use of preventive training. To overcome barriers, players and coaches gave examples of how to tailor preventive programmes, such as adding joyful sport specific components. Player-perceived improved performance, with increased strength and speed from the preventive training, could be a promoting factor to increase motivation and enable IPEP use. Players and coaches offered examples of how to adapt and progress the preventive training by progressing gradually and choosing exercises that fit the team. Coaches emphasised that preventive training is important but difficult to prioritise in time-limited training sessions. Coaches’ suggestions to overcome barriers were through collaboration and support from other coaches, to start using the IPEP at an early age, to keep it simple and motivating the players with, for example, positive role models. Players found the Knee Control exercises boring but necessary for injury prevention. Sometimes, coaches felt uncertain of their competence to use the Knee Control programmes and wished for support from the federation, club and other coaches. Players and coaches shared ideas on how to overcome barriers to IPEP use, such as to increase players’ motivation, having a good structure, setting up routines for preventive training and to tailor the preventive training to the team. These findings can be used to further develop practical workshops and recommendations for programme use for players and coaches in youth team ball sports.