Search

BIO DESIGN

pISSN 1225-8962
eISSN 2287-982X

Article

Article

Original Article

Split Viewer

Phys. Ther. Korea 2022; 29(3): 241-248

Published online August 20, 2022

https://doi.org/10.12674/ptk.2022.29.3.241

© Korean Research Society of Physical Therapy

Sports Injury and Physiotherapy Services in the 2018 PyeongChang Winter Paralympic Games: Considerations and Potential Recommendations for Future Paralympics

Haeun Park1 , PT, BPT, Joon Young Chang2,3 , MSc, PT, Jongseok Hwang1 , PhD, PT, Young Hee Lee2,3,4 , PhD, MD, Joshua (Sung) Hyun You1,3 , PT, PhD

1Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, 2Yonsei Institute of Sports Science and Exercise Medicine, Wonju, 3PyeongChang Organizing Committee for the 2018 Olympic & Paralympic Games, PyeongChang, 4Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea

Correspondence to: Joshua (Sung) Hyun You
E-mail: neurorehab@yonsei.ac.kr
https://orcid.org/0000-0001-9931-2466

Received: April 15, 2022; Revised: April 29, 2022; Accepted: May 4, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: The PyeongChang 2018 Winter Paralympic Games (WPG) being one of the most successful Paralympic Games (PG) in modern athletic world history, hosted the largest number of elite athletes representing 49 National Paralympic Committees (NPCs). Objects: The present investigation highlighted the demographic and clinical characteristics of injured athletes and non-athletes and the physiotherapy services provided during the PyeongChang 2018 WPG.
Methods: Prospective descriptive epidemiology study, in which the study group comprised of 201 participants (51 athletes and 150 non-athletes) who were admitted to and utilized the polyclinic physiotherapy service of 2018 PyeongChang WPG in Physiotherapy Department of Paralympic Village from March 1, 2018 to March 20, 2018.
Results: Qualitative frequency analysis of injury type demonstrated highest number of chronic injuries (51%, n = 100) in athletes and non-athletes. Anatomical injury site analysis revealed that the spine and shoulder areas were affected with equal frequency for athletes (54.9%, n = 14), whereas for non-athletes, the frequencies of spine and shoulder area injuries were 36.7% (n = 55) and 26% (n = 39), respectively. The Pyeongchang WPG showed a high rate of athletes visiting the physiotherapy service during the pre-competition period (33.3%, n = 50), which may have led to smaller incidence rate of traumatic injury. The physiotherapy treatment service analysis demonstrated that manual therapy (35.4%, n = 230) was most commonly utilized, followed by transcutaneous electrical nerve stimulation/interference current therapy (TENS/ICT), therapeutic massage and therapeutic exercise.
Conclusion: We established the importance of prophylactic and preventive physiotherapy services to reduce the risk of sports injuries during WPG.

Keywords: Athletes, Athletic injuries, Para-athletes, Paralympians, Physical therapy

The PyeongChang 2018 Winter Paralympic Games (WPG) was one of the most successful legacy Paralympic Games (PG) in modern athletic world history, hosting the largest number of elite athletes (569 athletes) and representing 49 National Paralympic Committees (NPCs) [1]. The Medical Commission of the International Paralympic Committee (IPC) has initiated a prospective injury surveillance and an associated provision of sports medicine and physiotherapy services project to better identify injury risk factors and develop effective management strategies. Recent prospective injury surveillance of the PG suggests a growing number of the athletes with disabilities reporting a variety of musculoskeletal injuries, particularly during the WPG [2,3].

1. Risk Factors Associated With Winter Paralympic Games and Physiotherapy Service

IPC and surveillance studies reported that as many as 502 elite athletes (44 NPCs) and 541 elite athletes (45 NPCs) who participated in the 2010 Vancouver and 2014 Sochi PG events, respectively, demonstrated a higher risk of injuries when compared to the Olympic Games events [4]. The sports medicine and physiotherapy service has been by far the most utilized at the Paralympic Village polyclinic (PVP) by both athletes and non-athletes, including residents of the village, family members, supporting staff, and volunteers. Hence, the highest standards and quality of sports medicine and physiotherapy services are paramount and frontline onsite prevention coupled with comprehensive PVP care over several Olympic games have been emphasized [5].

Despite the importance of high standard and quality of physiotherapy care, there is a dearth of information on the epidemiology of sports injury and related physiotherapy services at the WPG in current literature. However, some sports injury and physiotherapy services can be predicted for certain sports-specific disciplines and equipment modifications (e.g. wheelchair curling, sledges) and prosthetics (e.g., stump socket) which predispose elite athletes to unique injuries [6-9]. Epidemiological injury surveillance has been done for every PG, but there is a limited number of WPG physiotherapy service-related studies reporting the epidemiology (onset time) of the sports injuries [1-3], especially with details about the anatomical region, number of injuries, high-incidence sports disciplines, nature of injury (acute or overuse), and treatment (number of treatments and modalities). Thus, the importance of physiotherapy services and preventive care have not been adequately addressed in the literature. In line with the mission and research objectives of the IPC, we have developed a neuro-musculoskeletal injury and physiotherapy service database, followed by a preliminary phase of data collection and analysis implemented at the PyeongChang 2018 WPG. The specific aim of the present project was to evaluate the demographic and clinical characteristics of injured athletes and non-athletes and the physiotherapy services provided during the PyeongChang 2018 WPG. Furthermore, we aimed to ascertain the importance of prophylactic preventive physiotherapy services to the risk of sports injury during WPG. The information obtained from this project would serve as a clinical guideline and shed light on the future of physiotherapy services required for athletes in upcoming WPG.

1. Participants

The study group comprised of 201 participants (51 athletes and 150 non-athletes) who were admitted to and utilized the polyclinic physiotherapy service from March 1, 2018 to March 20, 2018. Informed consent was provided by all participants for the use of de-identified medical data gathered during the Games. Paralympic athletes participated in five major sports disciplines: Para alpine skiing, Para snowboard, Para Nordic skiing (combining Para cross country skiing and Para biathlon), Para ice hockey, and wheelchair curling [1]. Non-athletes include: coaches, Olympic families, work forces, and other staffs.

The IPC medical committee members provided a preliminary investigation plan for sports medicine and physiotherapy services prior to the Games via email to all the NPCs chefs de mission (n = 49). Further detailed information about the current study was provided at a medical briefing and during individualized training sessions, which took place during the pre-competition period with 41 team physicians and medical staff attending, at the chefs de mission hall.

The study was implemented by members of the IPC Medical Committee and approved by the Institutional Review Board of Yonsei Unversity Wonju Severance Christian Hospital (IRB no. CR320022). The physiotherapy service procedure and data collection were approved by the PyeongChang 2018 Medical Service Committee for the PG.

2. Defining Injury and Physiotherapy Service

We defined injuries and illnesses as a “complaint of sports-related musculoskeletal that caused the athlete to seek medical attention during the study period, regardless of the athlete’s ability to continue with training or competition [3].” Injuries were categorized into three types: acute (pre-existing and partially rehabilitated conditions were not included), recurring (same type of injuries that occur repeatedly at the same location on the body [10]), or chronic (a type of “overuse syndrome” which reflects an accumulation of unrepaired, relatively minor damage [11]).

The IPC classifies sports into ten categories; however, we reorganized the data into five impairment types based on the web-based injury and illness capturing system (WEB-IISS). Characteristics of each impairment type have been defined in Table 1.

Table 1 . Description of impairment types.

TypeDescription
Spinal cord injuryAll those athletes having a spinal cord lesion, spina bifida or polio.
Cerebral palsyA condition in which damage inflicted on the brain has led to motor function disorder.
Limb deficiencyTotal or partial absence of bones or joints as a consequence of trauma, illness or congenital limb deficiency.
Vision impairmentVision impacted either by an impairment of the eye structure, optical nerves or optical pathways, or the visual cortex.
AmbulatoryGuide runners


The five major comprehensive physiotherapy services included advice (counseling, consultation, referral), therapeutic exercise, manual manipulative therapy, therapeutic modalities, and assistive (prophylactic) devices. A specific description of the sub-categories has been presented in Table 2. The selection of physiotherapy service items was based on the recommendation and guidelines of International Olympic Committee (IOC)/IPC medical commissions and clinical evidence in current literature.

Table 2 . A specific description of the comprehensive physiotherapy service sub-categories.

ServiceDescription
AdviceCounseling, consultation, referral, and reassurance
Therapeutic exerciseStrengthening, eccentric, flexibility, balance, rehabilitation, general exercise, gait re-education, and muscle strengthening
Assistive (prophylactic) deviceTapingStrapping/compression, strapping (fixation/supportive), preventive taping, treatment taping, pre-competition taping, post-competition taping, preventive kinesiotaping, and treatment kinesiotaping
Manual manipulative therapyManualJoint manipulation, joint mobilization, soft tissue mobilization, myofascial release techniques, trigger point therapy, muscle energy techniques, and pressure biofeedback
TractionManual traction
MassageTreatment massage, general, pre-event, inter-event, and recovery/regeneration
Therapeutic modalitiesCryotherapyIce pack and cryotherapy/cryocuff
HeatThermal collar and moist heat pack
TENS/ICTInterferential current therapy and neuromuscular stimulation
LaserLaser therapy
ShockwaveShockwave therapy
UltrasoundUltrasound therapy


3. Availability, Access and Staff Allocation

Physiotherapy services were provided in the PVP to support all the medical needs associated with preventive or prophylactic services, sports injuries and recurrent or chronic injuries for 569 athletes and non-athletes for 20 days, from March 1, 2018 to March 20, 2018, including the pre-competition period (March 1 to March 8), competition period (March 9 to March 18), and post-competition period (March 19 to March 20). The operating hours were from 7:00 AM to 11:00 PM. The physiotherapy department in the PVP was easily accessible due to its central location.

A total of 18 top Korean sports physiotherapists were involved in the service. The physiotherapists were divided into two separate shifts of morning and night, with each shift lasting eight hours and staffed by eight therapists. The service was administered by a chief physiotherapist (Sung H. You, PhD, PT, Yonsei University Mirae Campus), one medical IPC doctor (Dr. Young H. Lee) and 18 professional sports physiotherapists. The physiotherapists played a critical role in providing treatment and rehabilitation for clients, along with initial assessments and evaluations to maximize performance of the para-athletes and prevent further injuries.

Each treatment involved a multidisciplinary approach where clients were first assessed by the medical doctor. The physiotherapists the administered the prescribed treatment consisting of different modalities including manual therapy and simple exercises. Re-visiting patients who came in for simple conditioning and/or pain control directly went to the physiotherapists in charge.

4. Medical Forms, Data Management, and Statistics

Physiotherapists utilized the ‘IPC EMS Physical Therapy Service Form’ to record initial examination of admitted patients. The electronic medical record (EMR) aimed to provide basic demographics, foundation of injury, physical assessment and available physical therapy treatment lists. A clear understanding of the injury profile (i.e., acute, recurring, or chronic) was needed to better understand and determine the treatment approaches and sports therapy disciplines to be used.

Data were sorted and organized using SPSS version 25 (IBM Co., Armonk, NY, USA). Descriptive statistical analyses of athletes and non-athletes were stated with date, number of reported injuries and number and percentage of physiotherapy modalities used for treatment. Additional data of athletes had number of athletes participating in five categories of paralympic sport.

Of 213 clients who visited the PVP for physiotherapy services, the details of 201 clients (94.8%) were recorded correctly in all categories. Of the 201 admitted clients, 51 were athletes (25.2%) and 150 were non-athletes (74.3%). The non-athlete category comprises coaches, Paralympic family, work force or staff.

1. Injury Incidence and Characteristics in Athletes and Non-athletes Who Utilized Physiotherapy Services

At the PyeongChang WPG, a total of 112 (54.4%) out of 567 athletes reported 142 injuries, amounting to an injury incidence rate (IR) of 20.9 per 1,000 athletes [1]. Among them, 51 athletes utilized the physiotherapy service. In the athletic population, chronic injuries were the most common (n = 29, 50.8%), followed by acute (n = 17, 34.4%) and recurrent injuries (n = 5, 19.8%) (Figure 1). This was also true for the non-athletic population, with chronic injuries (n = 71, 47.1%) being the most prevalent, followed by acute (n = 63, 40.6%) and recurrent injuries (n = 16, 11%).

Figure 1. Injury categorization of admitted patients.

The injured anatomical area was identified during consultation at the first visit. Ten athletes complained of injuries in multiple anatomical sites (19.6%). The most common anatomical areas with injuries in athletes were the shoulder and spine (n = 14), followed by the head/neck (n = 7) (Figure 2). A similar trend was seen in the injury surveillance study of the PyeongChang WPG, which documented the shoulder/arm/elbow area as the most frequently injured site [1]. In non-athlete clients, the spine was the most prevalent site of injury (n = 55), followed by the shoulder (n = 39) and head/neck (n = 21) (Figure 2). Thirty clients presented multiple anatomical sites of injury. The most frequently occurring type of injury for both athletes and non-athletes was muscle strain/tear (n = 95, 47.3%) (Figure 3).



2. Physiotherapy Service Admissions

Most of the athletes and non-athletes utilized the physiotherapy service during the competition period (μ = 35, visits per day) (Figure 4). Thirty-two athletes (62.7%) and 55 non-athletes (36.6%) visited the physiotherapy service than once, with the percentages indicating that athletes had higher follow-up visit rates than non-athletes. The highest rate of admission was seen among athletes of wheelchair curling (13.3%), followed by alpine skiing (10.6%), nordic skiing (8.8%), snowboard (8.3%), and ice hockey (5.9%) (Table 3).

Table 3 . Number of all participating athletes and admitted patients based on sport category.

CategoryAdmittedTotal
Alpine skiing15 (10.6)141
Nordic skiing14 (8.8)159
Ice hockey8 (5.9)135
Wheelchair curling8 (13.3)60
Snowboard6 (8.3)72

Values are presented as number (%) or number only..




Figure 4 shows that more athletes than non-athletes sought out physiotherapy services during the pre-competition period. During the pre-competition period, 49 of 147 treatment sessions occurred in athletes (33.3%), whereas 45 of 291 treatment sessions took place for in non-athletes (15.5%), showing a higher percentage of treatment sessions in athletes during this period.

3. Physiotherapy Services

The modalities used for physiotherapy service have been described in Figure 5. The three most utilized physiotherapeutic modalities for treatment sessions were manual (n = 230, 35.4%), transcutaneous electrical nerve stimulation/interference current therapy (TENS/ICT) (n = 82, 12.6%) and massage (n = 77, 11.8%). Heat therapy, cryotherapy, taping, therapeutic exercises, ultrasound and advice were also used for some cases. Laser, shockwave and traction were used in very few cases.

The present investigation was proposed to highlight the injury incidence and characteristics, physiotherapy admissions and physiotherapy services provided during the PyeongChang 2018 WPG. The strategic challenges in planning physiotherapy services for a major event such as the Athens 2004 Summer PG are well documented [12], but specific guidelines and physiotherapy service operations designed to meet emerging challenges at the WPG have not been clearly delineated in current literature. Therefore, we have emphasized the need to provide physiotherapy service-related information, which will be crucial in developing systematic injury prevention and physiotherapy service programs and guidelines for the safety and optimal performance of athletes in upcoming WPG.

1. Injury Incidence and Characteristics in Athletes and Non-athletes Who Utilized Physiotherapy Services

Qualitative frequency analysis of injury type demonstrated that chronic injuries were 51% and 47% more prevalent than acute or recurrent injuries in athletes and non-athletes, respectively. This finding was consistent with a previous study showing a prevalence of 60% for chronic injuries in athletes at the 2010 Vancouver WPG [3], suggesting that increased levels of training over the years have caused more chronic injuries due to overuse [3]. Further studies to investigate effective prevention for injuries that occur during training and competition are needed.

During the PyeongChang WPG, the injury type for which both athletes and non-athletes were most frequently admitted was muscle strain/tear (58.8% and 43.3%, respectively). This result differs from previously reported data, which indicated that soft tissue injuries were the most commonly occurring injury type among athletes with disabilities [13,14]. Our findings highlight the importance of warm-up and conditioning before training.

Anatomical injury site analysis revealed that the spine and shoulder areas were affected with equal frequency for athletes (54.9%), whereas for non-athletes, the frequencies of spine and shoulder area injuries were 36.7% and 26%, respectively. This result was similar with previous reports from the 2014 Sochi WPG (24.1%) and 2004 Athens WPG (22.2% for spine injury, 18.5% for shoulder injury), which showed that athletes experienced highest injury occurrence in the shoulder and spine [2,12]. As per existing literature, shoulder injuries occur more frequently in wheelchair athletes and spine injuries are seen more frequently in amputee athletes [7]. Shoulders are the primary weight-bearing joints in wheelchair athletes, possibly contributing to the high incidence of overuse injuries [8,15]. Moreover, upper and lower extremity amputees generally complain of spinal injuries due to compensation and muscular imbalance, which cause asymmetric movements in the limbs during training and competition [8,15]. Physiotherapy sessions should focus on strengthening of imbalanced muscles and stretching for flexibility, as well as manual therapy for relaxation of taut structures [7]. Thus, this study has identified areas at risk of injury in Paralympic athletes, and can inform injury prevention programs and policy change regarding athlete safety in future WPG.

2. Physiotherapy Admissions and Treatment Sessions

It has recently been reported that the Para snowboard athletes had the highest IR of injury in the PyeongChang WPG [1]. Interestingly, despite such high injury incidence in the Para snowboard athletes, we found that the admission status was highest for wheelchair curling (13.3%), followed by alpine skiing (10.6%), nordic skiing (8.8%), snowboard (8.3%), and ice hockey (5.9%) (Table 3). We anticipated that Para snowboard athletes would demonstrate the most frequent physiotherapy admission and service utilization rates based on the incidence report, which found as many as 59 of 72 competing Para snowboard athletes with acute traumatic injuries (82%). Furthermore, the Para snowboard event was adopted as an individual WPG category for the first time at the PyeongChang WPG [1]. The underutilization of the physiotherapy admission service by the snowboard athletes may be due to the fact that the medical staff or physiotherapists of the respective national teams were employed for primary care, failing which participants were referred to the PyeongChang WPG polyclinic physiotherapy service. The number of admissions based on the type of impairment of athletes and sports category was also analyzed (Table 4). Athletes with more diverse impairment types participated in alpine and Nordic skiing, whereas athletes with spinal cord injury and limb deficiency primarily competed in wheelchair curling and Nordic skiing.

Table 4 . Number of admissions based on type of impairment and sports category (N = 51).

Wheelchair curlingIce hockeyNordic skiingAlpine skiingSnow boardTotal
Spinal cord injury8410013 (25.5)
Cerebral palsy001214 (7.8)
Limb deficiency0463518 (35.3)
Vision impairment001506 (11.8)
Ambulatory0055010 (19.6)
Total881415651 (100.0)

Values are presented as number only or number (%)..



3. Physiotherapy Service

The physiotherapy treatment service analysis demonstrated that manual therapy (35.4%), including DR.YOUSTM instrument-assisted soft tissue mobilization, McKenzie mechanical diagnosis and treatment, joint mobilization and manipulation were most commonly utilized, followed by TENS/ICT, therapeutic massage, therapeutic exercise, ultrasound and heat therapy. For acute injuries, electrical modalities including TENS/ICT and ultrasound along with cryotherapy and icing were most frequently used to control inflammation, pain, and swelling. For the subacute and chronic conditions, manual therapy along with therapeutic massage, heat therapy and therapeutic exercise were used. Taping, traction, shockwave and laser therapy were also used occasionally for patients with localized pain or for injury prevention.

The outcome of the study confirms that our physiotherapy service was systemically delivered by the most qualified and experienced (elite) sports physiotherapy professionals with the highest educational credentials. Most professionals had final degrees of MS or PhD in the field of physical therapy profession and evidence-based approaches to maximize rapid recovery of acute and chronic injuries. The majority of the attending sports physiotherapy professionals are trained in manual sports therapy for national, international, and Olympic athletes. In the polyclinic, we closely collaborated with physiatrists, orthopedists, prosthetic and orthosis specialists, Korean medical doctors for acupuncture services, ophthalmologists, and dentists as a medical team.

4. Limitations

The EMR that was designed for the WPG was employed during the PyeongChang 2018 WPG without a prior validation process. As such, different injury surveillance and clinical characteristics of injured athletes between the WPG and Winter Olympic Games exist and may mandate for a modified EMR. Nevertheless, the present Olympic Games EMR system seems to be sufficient to address the fundamental injury surveillance and clinical characteristics of injured athletes as anticipated. However, a further study should be implemented to determine the validity and reliability of the EMR for WPG before we adapt the system as a standardized assessment.

The present investigation highlights the first injury surveillance and clinical characteristics of injured athletes and non-athletes and physiotherapy services provided during the PyeongChang 2018 WPG. We established the important clinical ramifications for sports injury management and preventive physiotherapy services to reduce the risk of sports injuries during WPG. The Olympic Games EMR system requires some degree of modification to incorporate the characteristics of Paralympic-participating athletes, which will provide invaluable information for future WPG projects.

This study was supported by the Brain Korea 21 PLUS Project Grant (No. 2021-51-0151) and the National Research Foundation of Korea grant funded by the Korean government (No. 2021R1A2C101342311) for the Department of Physical Therapy in Graduate School, Yonsei University.

No potential conflict of interest relevant to this article was reported.

Conceptualization: HP, JHY. Data curation: JYC, JH, YHL, JHY. Formal analysis: HP, JYC, JHY. Investigation: JYC, JH, JHY. Methodology: HP, JYC, JHY. Project administration: HP, YHL, JHY. Resources: JYC, JH, YHL, JHY. Supervision: HP, JH, YHL, JHY. Validation: YHL, JHY. Visualization: HP, JHY. Writing - original draft: HP, JH, JHY. Writing - review & editing: HP, YHL, JHY.

  1. Derman W, Runciman P, Jordaan E, Schwellnus M, Blauwet C, Webborn N, et al. High incidence of injuries at the Pyeongchang 2018 Paralympic Winter Games: a prospective cohort study of 6804 athlete days. Br J Sports Med 2020;54(1):38-43.
    Pubmed CrossRef
  2. Derman W, Schwellnus MP, Jordaan E, Runciman P, Blauwet C, et al.; Van de Vliet P. High incidence of injury at the Sochi 2014 Winter Paralympic Games: a prospective cohort study of 6564 athlete days. Br J Sports Med 2016;50(17):1069-74.
    Pubmed CrossRef
  3. Webborn N, Willick S, Emery CA. The injury experience at the 2010 winter paralympic games. Clin J Sport Med 2012;22(1):3-9.
    Pubmed CrossRef
  4. Official Website of the Paralympic Movement. Injury and illness surveys. . International Paralympic Committee [Internet]. Bonn: 2020[cited 2020 Mar 20].
    Available from: https://www.paralympic.org/medical/injury-and-illness-surveys.
  5. Grant ME, Steffen K, Glasgow P, Phillips N, Booth L, Galligan M. The role of sports physiotherapy at the London 2012 Olympic Games. Br J Sports Med 2014;48(1):63-70.
    Pubmed CrossRef
  6. Curtis KA, Dillon DA. Survey of wheelchair athletic injuries: common patterns and prevention. Paraplegia 1985;23(3):170-5.
    Pubmed CrossRef
  7. Klenck C, Gebke K. Practical management: common medical problems in disabled athletes. Clin J Sport Med 2007;17(1):55-60.
    Pubmed CrossRef
  8. CrossRef
  9. Vanlandewijck Y, Theisen D, Daly D. Wheelchair propulsion biomechanics: implications for wheelchair sports. Sports Med 2001;31(5):339-67.
    Pubmed CrossRef
  10. Swenson DM, Yard EE, Fields SK, Comstock RD. Patterns of recurrent injuries among US high school athletes, 2005-2008. Am J Sports Med 2009;37(8):1586-93.
    Pubmed CrossRef
  11. CrossRef
  12. Athanasopoulos S, Mandalidis D, Tsakoniti A, Athanasopoulos I, Strimpakos N, Papadopoulos E, et al. The 2004 paralympic games: physiotherapy services in the paralympic village polyclinic. Open Sports Med J 2009;3:9-13.
    CrossRef
  13. Nyland J, Snouse SL, Anderson M, Kelly T, Sterling JC. Soft tissue injuries to USA paralympians at the 1996 summer games. Arch Phys Med Rehabil 2000;81(3):368-73.
    Pubmed CrossRef
  14. Reynolds J, Stirk A, Thomas A, Geary F. Paralympics--Barcelona 1992. Br J Sports Med 1994;28(1):14-7.
    Pubmed KoreaMed CrossRef
  15. Halpern BC, Bochm R, Cardone DA. The disabled athlete. In: Garrett WE, Kirkendall DT, Squire DL editorss. Principles and practice of primary care sports medicine. Philadelphia (PA): Lippincott Williams & Wilkins; 2001;115-32.
    CrossRef

Article

Original Article

Phys. Ther. Korea 2022; 29(3): 241-248

Published online August 20, 2022 https://doi.org/10.12674/ptk.2022.29.3.241

Copyright © Korean Research Society of Physical Therapy.

Sports Injury and Physiotherapy Services in the 2018 PyeongChang Winter Paralympic Games: Considerations and Potential Recommendations for Future Paralympics

Haeun Park1 , PT, BPT, Joon Young Chang2,3 , MSc, PT, Jongseok Hwang1 , PhD, PT, Young Hee Lee2,3,4 , PhD, MD, Joshua (Sung) Hyun You1,3 , PT, PhD

1Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, 2Yonsei Institute of Sports Science and Exercise Medicine, Wonju, 3PyeongChang Organizing Committee for the 2018 Olympic & Paralympic Games, PyeongChang, 4Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea

Correspondence to:Joshua (Sung) Hyun You
E-mail: neurorehab@yonsei.ac.kr
https://orcid.org/0000-0001-9931-2466

Received: April 15, 2022; Revised: April 29, 2022; Accepted: May 4, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: The PyeongChang 2018 Winter Paralympic Games (WPG) being one of the most successful Paralympic Games (PG) in modern athletic world history, hosted the largest number of elite athletes representing 49 National Paralympic Committees (NPCs). Objects: The present investigation highlighted the demographic and clinical characteristics of injured athletes and non-athletes and the physiotherapy services provided during the PyeongChang 2018 WPG.
Methods: Prospective descriptive epidemiology study, in which the study group comprised of 201 participants (51 athletes and 150 non-athletes) who were admitted to and utilized the polyclinic physiotherapy service of 2018 PyeongChang WPG in Physiotherapy Department of Paralympic Village from March 1, 2018 to March 20, 2018.
Results: Qualitative frequency analysis of injury type demonstrated highest number of chronic injuries (51%, n = 100) in athletes and non-athletes. Anatomical injury site analysis revealed that the spine and shoulder areas were affected with equal frequency for athletes (54.9%, n = 14), whereas for non-athletes, the frequencies of spine and shoulder area injuries were 36.7% (n = 55) and 26% (n = 39), respectively. The Pyeongchang WPG showed a high rate of athletes visiting the physiotherapy service during the pre-competition period (33.3%, n = 50), which may have led to smaller incidence rate of traumatic injury. The physiotherapy treatment service analysis demonstrated that manual therapy (35.4%, n = 230) was most commonly utilized, followed by transcutaneous electrical nerve stimulation/interference current therapy (TENS/ICT), therapeutic massage and therapeutic exercise.
Conclusion: We established the importance of prophylactic and preventive physiotherapy services to reduce the risk of sports injuries during WPG.

Keywords: Athletes, Athletic injuries, Para-athletes, Paralympians, Physical therapy

INTRODUCTION

The PyeongChang 2018 Winter Paralympic Games (WPG) was one of the most successful legacy Paralympic Games (PG) in modern athletic world history, hosting the largest number of elite athletes (569 athletes) and representing 49 National Paralympic Committees (NPCs) [1]. The Medical Commission of the International Paralympic Committee (IPC) has initiated a prospective injury surveillance and an associated provision of sports medicine and physiotherapy services project to better identify injury risk factors and develop effective management strategies. Recent prospective injury surveillance of the PG suggests a growing number of the athletes with disabilities reporting a variety of musculoskeletal injuries, particularly during the WPG [2,3].

1. Risk Factors Associated With Winter Paralympic Games and Physiotherapy Service

IPC and surveillance studies reported that as many as 502 elite athletes (44 NPCs) and 541 elite athletes (45 NPCs) who participated in the 2010 Vancouver and 2014 Sochi PG events, respectively, demonstrated a higher risk of injuries when compared to the Olympic Games events [4]. The sports medicine and physiotherapy service has been by far the most utilized at the Paralympic Village polyclinic (PVP) by both athletes and non-athletes, including residents of the village, family members, supporting staff, and volunteers. Hence, the highest standards and quality of sports medicine and physiotherapy services are paramount and frontline onsite prevention coupled with comprehensive PVP care over several Olympic games have been emphasized [5].

Despite the importance of high standard and quality of physiotherapy care, there is a dearth of information on the epidemiology of sports injury and related physiotherapy services at the WPG in current literature. However, some sports injury and physiotherapy services can be predicted for certain sports-specific disciplines and equipment modifications (e.g. wheelchair curling, sledges) and prosthetics (e.g., stump socket) which predispose elite athletes to unique injuries [6-9]. Epidemiological injury surveillance has been done for every PG, but there is a limited number of WPG physiotherapy service-related studies reporting the epidemiology (onset time) of the sports injuries [1-3], especially with details about the anatomical region, number of injuries, high-incidence sports disciplines, nature of injury (acute or overuse), and treatment (number of treatments and modalities). Thus, the importance of physiotherapy services and preventive care have not been adequately addressed in the literature. In line with the mission and research objectives of the IPC, we have developed a neuro-musculoskeletal injury and physiotherapy service database, followed by a preliminary phase of data collection and analysis implemented at the PyeongChang 2018 WPG. The specific aim of the present project was to evaluate the demographic and clinical characteristics of injured athletes and non-athletes and the physiotherapy services provided during the PyeongChang 2018 WPG. Furthermore, we aimed to ascertain the importance of prophylactic preventive physiotherapy services to the risk of sports injury during WPG. The information obtained from this project would serve as a clinical guideline and shed light on the future of physiotherapy services required for athletes in upcoming WPG.

MATERIALS AND METHODS

1. Participants

The study group comprised of 201 participants (51 athletes and 150 non-athletes) who were admitted to and utilized the polyclinic physiotherapy service from March 1, 2018 to March 20, 2018. Informed consent was provided by all participants for the use of de-identified medical data gathered during the Games. Paralympic athletes participated in five major sports disciplines: Para alpine skiing, Para snowboard, Para Nordic skiing (combining Para cross country skiing and Para biathlon), Para ice hockey, and wheelchair curling [1]. Non-athletes include: coaches, Olympic families, work forces, and other staffs.

The IPC medical committee members provided a preliminary investigation plan for sports medicine and physiotherapy services prior to the Games via email to all the NPCs chefs de mission (n = 49). Further detailed information about the current study was provided at a medical briefing and during individualized training sessions, which took place during the pre-competition period with 41 team physicians and medical staff attending, at the chefs de mission hall.

The study was implemented by members of the IPC Medical Committee and approved by the Institutional Review Board of Yonsei Unversity Wonju Severance Christian Hospital (IRB no. CR320022). The physiotherapy service procedure and data collection were approved by the PyeongChang 2018 Medical Service Committee for the PG.

2. Defining Injury and Physiotherapy Service

We defined injuries and illnesses as a “complaint of sports-related musculoskeletal that caused the athlete to seek medical attention during the study period, regardless of the athlete’s ability to continue with training or competition [3].” Injuries were categorized into three types: acute (pre-existing and partially rehabilitated conditions were not included), recurring (same type of injuries that occur repeatedly at the same location on the body [10]), or chronic (a type of “overuse syndrome” which reflects an accumulation of unrepaired, relatively minor damage [11]).

The IPC classifies sports into ten categories; however, we reorganized the data into five impairment types based on the web-based injury and illness capturing system (WEB-IISS). Characteristics of each impairment type have been defined in Table 1.

Table 1 . Description of impairment types.

TypeDescription
Spinal cord injuryAll those athletes having a spinal cord lesion, spina bifida or polio.
Cerebral palsyA condition in which damage inflicted on the brain has led to motor function disorder.
Limb deficiencyTotal or partial absence of bones or joints as a consequence of trauma, illness or congenital limb deficiency.
Vision impairmentVision impacted either by an impairment of the eye structure, optical nerves or optical pathways, or the visual cortex.
AmbulatoryGuide runners


The five major comprehensive physiotherapy services included advice (counseling, consultation, referral), therapeutic exercise, manual manipulative therapy, therapeutic modalities, and assistive (prophylactic) devices. A specific description of the sub-categories has been presented in Table 2. The selection of physiotherapy service items was based on the recommendation and guidelines of International Olympic Committee (IOC)/IPC medical commissions and clinical evidence in current literature.

Table 2 . A specific description of the comprehensive physiotherapy service sub-categories.

ServiceDescription
AdviceCounseling, consultation, referral, and reassurance
Therapeutic exerciseStrengthening, eccentric, flexibility, balance, rehabilitation, general exercise, gait re-education, and muscle strengthening
Assistive (prophylactic) deviceTapingStrapping/compression, strapping (fixation/supportive), preventive taping, treatment taping, pre-competition taping, post-competition taping, preventive kinesiotaping, and treatment kinesiotaping
Manual manipulative therapyManualJoint manipulation, joint mobilization, soft tissue mobilization, myofascial release techniques, trigger point therapy, muscle energy techniques, and pressure biofeedback
TractionManual traction
MassageTreatment massage, general, pre-event, inter-event, and recovery/regeneration
Therapeutic modalitiesCryotherapyIce pack and cryotherapy/cryocuff
HeatThermal collar and moist heat pack
TENS/ICTInterferential current therapy and neuromuscular stimulation
LaserLaser therapy
ShockwaveShockwave therapy
UltrasoundUltrasound therapy


3. Availability, Access and Staff Allocation

Physiotherapy services were provided in the PVP to support all the medical needs associated with preventive or prophylactic services, sports injuries and recurrent or chronic injuries for 569 athletes and non-athletes for 20 days, from March 1, 2018 to March 20, 2018, including the pre-competition period (March 1 to March 8), competition period (March 9 to March 18), and post-competition period (March 19 to March 20). The operating hours were from 7:00 AM to 11:00 PM. The physiotherapy department in the PVP was easily accessible due to its central location.

A total of 18 top Korean sports physiotherapists were involved in the service. The physiotherapists were divided into two separate shifts of morning and night, with each shift lasting eight hours and staffed by eight therapists. The service was administered by a chief physiotherapist (Sung H. You, PhD, PT, Yonsei University Mirae Campus), one medical IPC doctor (Dr. Young H. Lee) and 18 professional sports physiotherapists. The physiotherapists played a critical role in providing treatment and rehabilitation for clients, along with initial assessments and evaluations to maximize performance of the para-athletes and prevent further injuries.

Each treatment involved a multidisciplinary approach where clients were first assessed by the medical doctor. The physiotherapists the administered the prescribed treatment consisting of different modalities including manual therapy and simple exercises. Re-visiting patients who came in for simple conditioning and/or pain control directly went to the physiotherapists in charge.

4. Medical Forms, Data Management, and Statistics

Physiotherapists utilized the ‘IPC EMS Physical Therapy Service Form’ to record initial examination of admitted patients. The electronic medical record (EMR) aimed to provide basic demographics, foundation of injury, physical assessment and available physical therapy treatment lists. A clear understanding of the injury profile (i.e., acute, recurring, or chronic) was needed to better understand and determine the treatment approaches and sports therapy disciplines to be used.

Data were sorted and organized using SPSS version 25 (IBM Co., Armonk, NY, USA). Descriptive statistical analyses of athletes and non-athletes were stated with date, number of reported injuries and number and percentage of physiotherapy modalities used for treatment. Additional data of athletes had number of athletes participating in five categories of paralympic sport.

RESULTS

Of 213 clients who visited the PVP for physiotherapy services, the details of 201 clients (94.8%) were recorded correctly in all categories. Of the 201 admitted clients, 51 were athletes (25.2%) and 150 were non-athletes (74.3%). The non-athlete category comprises coaches, Paralympic family, work force or staff.

1. Injury Incidence and Characteristics in Athletes and Non-athletes Who Utilized Physiotherapy Services

At the PyeongChang WPG, a total of 112 (54.4%) out of 567 athletes reported 142 injuries, amounting to an injury incidence rate (IR) of 20.9 per 1,000 athletes [1]. Among them, 51 athletes utilized the physiotherapy service. In the athletic population, chronic injuries were the most common (n = 29, 50.8%), followed by acute (n = 17, 34.4%) and recurrent injuries (n = 5, 19.8%) (Figure 1). This was also true for the non-athletic population, with chronic injuries (n = 71, 47.1%) being the most prevalent, followed by acute (n = 63, 40.6%) and recurrent injuries (n = 16, 11%).

Figure 1. Injury categorization of admitted patients.

The injured anatomical area was identified during consultation at the first visit. Ten athletes complained of injuries in multiple anatomical sites (19.6%). The most common anatomical areas with injuries in athletes were the shoulder and spine (n = 14), followed by the head/neck (n = 7) (Figure 2). A similar trend was seen in the injury surveillance study of the PyeongChang WPG, which documented the shoulder/arm/elbow area as the most frequently injured site [1]. In non-athlete clients, the spine was the most prevalent site of injury (n = 55), followed by the shoulder (n = 39) and head/neck (n = 21) (Figure 2). Thirty clients presented multiple anatomical sites of injury. The most frequently occurring type of injury for both athletes and non-athletes was muscle strain/tear (n = 95, 47.3%) (Figure 3).

Figure 2. Number of admissions classified based on injured anatomical area.

Figure 3. Physiotherapy modalities used. TENS/ICT, transcutaneous electrical nerve stimulation/interference current therapy.

2. Physiotherapy Service Admissions

Most of the athletes and non-athletes utilized the physiotherapy service during the competition period (μ = 35, visits per day) (Figure 4). Thirty-two athletes (62.7%) and 55 non-athletes (36.6%) visited the physiotherapy service than once, with the percentages indicating that athletes had higher follow-up visit rates than non-athletes. The highest rate of admission was seen among athletes of wheelchair curling (13.3%), followed by alpine skiing (10.6%), nordic skiing (8.8%), snowboard (8.3%), and ice hockey (5.9%) (Table 3).

Table 3 . Number of all participating athletes and admitted patients based on sport category.

CategoryAdmittedTotal
Alpine skiing15 (10.6)141
Nordic skiing14 (8.8)159
Ice hockey8 (5.9)135
Wheelchair curling8 (13.3)60
Snowboard6 (8.3)72

Values are presented as number (%) or number only..



Figure 4. Treatment sessions sorted by date.

Figure 4 shows that more athletes than non-athletes sought out physiotherapy services during the pre-competition period. During the pre-competition period, 49 of 147 treatment sessions occurred in athletes (33.3%), whereas 45 of 291 treatment sessions took place for in non-athletes (15.5%), showing a higher percentage of treatment sessions in athletes during this period.

3. Physiotherapy Services

The modalities used for physiotherapy service have been described in Figure 5. The three most utilized physiotherapeutic modalities for treatment sessions were manual (n = 230, 35.4%), transcutaneous electrical nerve stimulation/interference current therapy (TENS/ICT) (n = 82, 12.6%) and massage (n = 77, 11.8%). Heat therapy, cryotherapy, taping, therapeutic exercises, ultrasound and advice were also used for some cases. Laser, shockwave and traction were used in very few cases.

Figure 5. Types of injuries in non-athletes and athletes. LBP, low back pain.

DISCUSSION

The present investigation was proposed to highlight the injury incidence and characteristics, physiotherapy admissions and physiotherapy services provided during the PyeongChang 2018 WPG. The strategic challenges in planning physiotherapy services for a major event such as the Athens 2004 Summer PG are well documented [12], but specific guidelines and physiotherapy service operations designed to meet emerging challenges at the WPG have not been clearly delineated in current literature. Therefore, we have emphasized the need to provide physiotherapy service-related information, which will be crucial in developing systematic injury prevention and physiotherapy service programs and guidelines for the safety and optimal performance of athletes in upcoming WPG.

1. Injury Incidence and Characteristics in Athletes and Non-athletes Who Utilized Physiotherapy Services

Qualitative frequency analysis of injury type demonstrated that chronic injuries were 51% and 47% more prevalent than acute or recurrent injuries in athletes and non-athletes, respectively. This finding was consistent with a previous study showing a prevalence of 60% for chronic injuries in athletes at the 2010 Vancouver WPG [3], suggesting that increased levels of training over the years have caused more chronic injuries due to overuse [3]. Further studies to investigate effective prevention for injuries that occur during training and competition are needed.

During the PyeongChang WPG, the injury type for which both athletes and non-athletes were most frequently admitted was muscle strain/tear (58.8% and 43.3%, respectively). This result differs from previously reported data, which indicated that soft tissue injuries were the most commonly occurring injury type among athletes with disabilities [13,14]. Our findings highlight the importance of warm-up and conditioning before training.

Anatomical injury site analysis revealed that the spine and shoulder areas were affected with equal frequency for athletes (54.9%), whereas for non-athletes, the frequencies of spine and shoulder area injuries were 36.7% and 26%, respectively. This result was similar with previous reports from the 2014 Sochi WPG (24.1%) and 2004 Athens WPG (22.2% for spine injury, 18.5% for shoulder injury), which showed that athletes experienced highest injury occurrence in the shoulder and spine [2,12]. As per existing literature, shoulder injuries occur more frequently in wheelchair athletes and spine injuries are seen more frequently in amputee athletes [7]. Shoulders are the primary weight-bearing joints in wheelchair athletes, possibly contributing to the high incidence of overuse injuries [8,15]. Moreover, upper and lower extremity amputees generally complain of spinal injuries due to compensation and muscular imbalance, which cause asymmetric movements in the limbs during training and competition [8,15]. Physiotherapy sessions should focus on strengthening of imbalanced muscles and stretching for flexibility, as well as manual therapy for relaxation of taut structures [7]. Thus, this study has identified areas at risk of injury in Paralympic athletes, and can inform injury prevention programs and policy change regarding athlete safety in future WPG.

2. Physiotherapy Admissions and Treatment Sessions

It has recently been reported that the Para snowboard athletes had the highest IR of injury in the PyeongChang WPG [1]. Interestingly, despite such high injury incidence in the Para snowboard athletes, we found that the admission status was highest for wheelchair curling (13.3%), followed by alpine skiing (10.6%), nordic skiing (8.8%), snowboard (8.3%), and ice hockey (5.9%) (Table 3). We anticipated that Para snowboard athletes would demonstrate the most frequent physiotherapy admission and service utilization rates based on the incidence report, which found as many as 59 of 72 competing Para snowboard athletes with acute traumatic injuries (82%). Furthermore, the Para snowboard event was adopted as an individual WPG category for the first time at the PyeongChang WPG [1]. The underutilization of the physiotherapy admission service by the snowboard athletes may be due to the fact that the medical staff or physiotherapists of the respective national teams were employed for primary care, failing which participants were referred to the PyeongChang WPG polyclinic physiotherapy service. The number of admissions based on the type of impairment of athletes and sports category was also analyzed (Table 4). Athletes with more diverse impairment types participated in alpine and Nordic skiing, whereas athletes with spinal cord injury and limb deficiency primarily competed in wheelchair curling and Nordic skiing.

Table 4 . Number of admissions based on type of impairment and sports category (N = 51).

Wheelchair curlingIce hockeyNordic skiingAlpine skiingSnow boardTotal
Spinal cord injury8410013 (25.5)
Cerebral palsy001214 (7.8)
Limb deficiency0463518 (35.3)
Vision impairment001506 (11.8)
Ambulatory0055010 (19.6)
Total881415651 (100.0)

Values are presented as number only or number (%)..



3. Physiotherapy Service

The physiotherapy treatment service analysis demonstrated that manual therapy (35.4%), including DR.YOUSTM instrument-assisted soft tissue mobilization, McKenzie mechanical diagnosis and treatment, joint mobilization and manipulation were most commonly utilized, followed by TENS/ICT, therapeutic massage, therapeutic exercise, ultrasound and heat therapy. For acute injuries, electrical modalities including TENS/ICT and ultrasound along with cryotherapy and icing were most frequently used to control inflammation, pain, and swelling. For the subacute and chronic conditions, manual therapy along with therapeutic massage, heat therapy and therapeutic exercise were used. Taping, traction, shockwave and laser therapy were also used occasionally for patients with localized pain or for injury prevention.

The outcome of the study confirms that our physiotherapy service was systemically delivered by the most qualified and experienced (elite) sports physiotherapy professionals with the highest educational credentials. Most professionals had final degrees of MS or PhD in the field of physical therapy profession and evidence-based approaches to maximize rapid recovery of acute and chronic injuries. The majority of the attending sports physiotherapy professionals are trained in manual sports therapy for national, international, and Olympic athletes. In the polyclinic, we closely collaborated with physiatrists, orthopedists, prosthetic and orthosis specialists, Korean medical doctors for acupuncture services, ophthalmologists, and dentists as a medical team.

4. Limitations

The EMR that was designed for the WPG was employed during the PyeongChang 2018 WPG without a prior validation process. As such, different injury surveillance and clinical characteristics of injured athletes between the WPG and Winter Olympic Games exist and may mandate for a modified EMR. Nevertheless, the present Olympic Games EMR system seems to be sufficient to address the fundamental injury surveillance and clinical characteristics of injured athletes as anticipated. However, a further study should be implemented to determine the validity and reliability of the EMR for WPG before we adapt the system as a standardized assessment.

CONCLUSIONS

The present investigation highlights the first injury surveillance and clinical characteristics of injured athletes and non-athletes and physiotherapy services provided during the PyeongChang 2018 WPG. We established the important clinical ramifications for sports injury management and preventive physiotherapy services to reduce the risk of sports injuries during WPG. The Olympic Games EMR system requires some degree of modification to incorporate the characteristics of Paralympic-participating athletes, which will provide invaluable information for future WPG projects.

ACKNOWLEDGEMENTS

None.

FUNDING

This study was supported by the Brain Korea 21 PLUS Project Grant (No. 2021-51-0151) and the National Research Foundation of Korea grant funded by the Korean government (No. 2021R1A2C101342311) for the Department of Physical Therapy in Graduate School, Yonsei University.

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

AUTHOR CONTRIBUTIONS

Conceptualization: HP, JHY. Data curation: JYC, JH, YHL, JHY. Formal analysis: HP, JYC, JHY. Investigation: JYC, JH, JHY. Methodology: HP, JYC, JHY. Project administration: HP, YHL, JHY. Resources: JYC, JH, YHL, JHY. Supervision: HP, JH, YHL, JHY. Validation: YHL, JHY. Visualization: HP, JHY. Writing - original draft: HP, JH, JHY. Writing - review & editing: HP, YHL, JHY.

Fig 1.

Figure 1.Injury categorization of admitted patients.
Physical Therapy Korea 2022; 29: 241-248https://doi.org/10.12674/ptk.2022.29.3.241

Fig 2.

Figure 2.Number of admissions classified based on injured anatomical area.
Physical Therapy Korea 2022; 29: 241-248https://doi.org/10.12674/ptk.2022.29.3.241

Fig 3.

Figure 3.Physiotherapy modalities used. TENS/ICT, transcutaneous electrical nerve stimulation/interference current therapy.
Physical Therapy Korea 2022; 29: 241-248https://doi.org/10.12674/ptk.2022.29.3.241

Fig 4.

Figure 4.Treatment sessions sorted by date.
Physical Therapy Korea 2022; 29: 241-248https://doi.org/10.12674/ptk.2022.29.3.241

Fig 5.

Figure 5.Types of injuries in non-athletes and athletes. LBP, low back pain.
Physical Therapy Korea 2022; 29: 241-248https://doi.org/10.12674/ptk.2022.29.3.241

Table 1 . Description of impairment types.

TypeDescription
Spinal cord injuryAll those athletes having a spinal cord lesion, spina bifida or polio.
Cerebral palsyA condition in which damage inflicted on the brain has led to motor function disorder.
Limb deficiencyTotal or partial absence of bones or joints as a consequence of trauma, illness or congenital limb deficiency.
Vision impairmentVision impacted either by an impairment of the eye structure, optical nerves or optical pathways, or the visual cortex.
AmbulatoryGuide runners

Table 2 . A specific description of the comprehensive physiotherapy service sub-categories.

ServiceDescription
AdviceCounseling, consultation, referral, and reassurance
Therapeutic exerciseStrengthening, eccentric, flexibility, balance, rehabilitation, general exercise, gait re-education, and muscle strengthening
Assistive (prophylactic) deviceTapingStrapping/compression, strapping (fixation/supportive), preventive taping, treatment taping, pre-competition taping, post-competition taping, preventive kinesiotaping, and treatment kinesiotaping
Manual manipulative therapyManualJoint manipulation, joint mobilization, soft tissue mobilization, myofascial release techniques, trigger point therapy, muscle energy techniques, and pressure biofeedback
TractionManual traction
MassageTreatment massage, general, pre-event, inter-event, and recovery/regeneration
Therapeutic modalitiesCryotherapyIce pack and cryotherapy/cryocuff
HeatThermal collar and moist heat pack
TENS/ICTInterferential current therapy and neuromuscular stimulation
LaserLaser therapy
ShockwaveShockwave therapy
UltrasoundUltrasound therapy

Table 3 . Number of all participating athletes and admitted patients based on sport category.

CategoryAdmittedTotal
Alpine skiing15 (10.6)141
Nordic skiing14 (8.8)159
Ice hockey8 (5.9)135
Wheelchair curling8 (13.3)60
Snowboard6 (8.3)72

Values are presented as number (%) or number only..


Table 4 . Number of admissions based on type of impairment and sports category (N = 51).

Wheelchair curlingIce hockeyNordic skiingAlpine skiingSnow boardTotal
Spinal cord injury8410013 (25.5)
Cerebral palsy001214 (7.8)
Limb deficiency0463518 (35.3)
Vision impairment001506 (11.8)
Ambulatory0055010 (19.6)
Total881415651 (100.0)

Values are presented as number only or number (%)..


References

  1. Derman W, Runciman P, Jordaan E, Schwellnus M, Blauwet C, Webborn N, et al. High incidence of injuries at the Pyeongchang 2018 Paralympic Winter Games: a prospective cohort study of 6804 athlete days. Br J Sports Med 2020;54(1):38-43.
    Pubmed CrossRef
  2. Derman W, Schwellnus MP, Jordaan E, Runciman P, Blauwet C, et al.; Van de Vliet P. High incidence of injury at the Sochi 2014 Winter Paralympic Games: a prospective cohort study of 6564 athlete days. Br J Sports Med 2016;50(17):1069-74.
    Pubmed CrossRef
  3. Webborn N, Willick S, Emery CA. The injury experience at the 2010 winter paralympic games. Clin J Sport Med 2012;22(1):3-9.
    Pubmed CrossRef
  4. Official Website of the Paralympic Movement. Injury and illness surveys. . International Paralympic Committee [Internet]. Bonn: 2020[cited 2020 Mar 20]. Available from: https://www.paralympic.org/medical/injury-and-illness-surveys.
  5. Grant ME, Steffen K, Glasgow P, Phillips N, Booth L, Galligan M. The role of sports physiotherapy at the London 2012 Olympic Games. Br J Sports Med 2014;48(1):63-70.
    Pubmed CrossRef
  6. Curtis KA, Dillon DA. Survey of wheelchair athletic injuries: common patterns and prevention. Paraplegia 1985;23(3):170-5.
    Pubmed CrossRef
  7. Klenck C, Gebke K. Practical management: common medical problems in disabled athletes. Clin J Sport Med 2007;17(1):55-60.
    Pubmed CrossRef
  8. CrossRef
  9. Vanlandewijck Y, Theisen D, Daly D. Wheelchair propulsion biomechanics: implications for wheelchair sports. Sports Med 2001;31(5):339-67.
    Pubmed CrossRef
  10. Swenson DM, Yard EE, Fields SK, Comstock RD. Patterns of recurrent injuries among US high school athletes, 2005-2008. Am J Sports Med 2009;37(8):1586-93.
    Pubmed CrossRef
  11. CrossRef
  12. Athanasopoulos S, Mandalidis D, Tsakoniti A, Athanasopoulos I, Strimpakos N, Papadopoulos E, et al. The 2004 paralympic games: physiotherapy services in the paralympic village polyclinic. Open Sports Med J 2009;3:9-13.
    CrossRef
  13. Nyland J, Snouse SL, Anderson M, Kelly T, Sterling JC. Soft tissue injuries to USA paralympians at the 1996 summer games. Arch Phys Med Rehabil 2000;81(3):368-73.
    Pubmed CrossRef
  14. Reynolds J, Stirk A, Thomas A, Geary F. Paralympics--Barcelona 1992. Br J Sports Med 1994;28(1):14-7.
    Pubmed KoreaMed CrossRef
  15. Halpern BC, Bochm R, Cardone DA. The disabled athlete. In: Garrett WE, Kirkendall DT, Squire DL editorss. Principles and practice of primary care sports medicine. Philadelphia (PA): Lippincott Williams & Wilkins; 2001;115-32.
    CrossRef