Multiple factors explain injury risk in adolescent elite athletes: Applying a biopsychosocial perspective

Abstract

Many risk factors for injury are presented in the literature, few of those are however consistent and the majority is associated with adult and not adolescent elite athletes. The aim was to identify risk factors for injury in adolescent elite athletes, by applying a biopsychosocial approach. A total of 496 adolescent elite athletes (age range 15-19), participating in 16 different sports, were monitored repeatedly over 52 weeks using a valid questionnaire about injuries, training exposure, sleep, stress, nutrition, and competence-based self-esteem. Univariate and multiple Cox regression analyses were used to calculate hazard ratios (HR) for risk factors for first reported injury. The main finding was that an increase in training load, training intensity, and at the same time decreasing the sleep volume resulted in a higher risk for injury compared to no change in these variables (HR 2.25, 95% CI, 1.46-3.45, P<.01), which was the strongest risk factor identified. In addition, an increase by one score of competence-based self-esteem increased the hazard for injury with 1.02 (HR 95% CI, 1.00-1.04, P=.01). Based on the multiple Cox regression analysis, an athlete having the identified risk factors (Risk Index, competence-based self-esteem), with an average competence-based self-esteem score, had more than a threefold increased risk for injury (HR 3.35), compared to an athlete with a low competence-based self-esteem and no change in sleep or training volume. Our findings confirm injury occurrence as a result of multiple risk factors interacting in complex ways.

Wake up call for collegiate athlete sleep: narrative review and consensus recommendations from the NCAA Interassociation Task Force on Sleep and Wellness

“…Similarly, a simultaneous increase in training load, training intensity and decreased hours of sleep resulted in a significantly higher risk of injury 24. College students with poor quality sleep also report significantly more medical illness than those with near-ideal or ideal sleep (as determined by an aggregation of factors including sleep quality and duration) 25.…”

Insomnia and daytime sleepiness: risk factors for sports-related concussion

“…Despite the lack of comprehensive analyses of sleep-related influences on injury risk, the present findings contribute to a larger body of work identifying poor or insufficient sleep as a contributory factor to sports-related injury risk. [42][43][44]68 Additionally, these findings contribute a critically absent piece of information to this literature base, highlighting the specific risk of sports-related concussion in the presence of poor sleep (e.g., insomnia) and daytime sleepiness. Furthermore, these findings identify a plausible means by which prior sports-related concussions increase future risk.…”

“…In addition to these adverse performance outcomes, less than optimal amounts of sleep (≤ 7-8 hours of sleep per night) is associated with increased injury risk. [42][43][44] However, prior investigations into injury risk have not specifically identified the risk for head injury or sportsrelated concussion. The purpose of this study was, therefore, to identify the extent to which selfreported, sleep-related outcomes affect the risk of sustaining a sports-related concussion in a sample of college athletes.…”

Subjective well-being is associated with injury risk in adolescent elite athletes

“…Data collection has previously been described in details (von Rosen et al, 2017). Briefly, the National Federations of Skiing, Orienteering, Handball and Track and Field were contacted and gave oral permission to conduct the study.…”