This is the largest and most comprehensive epidemiological report examining injuries in Paralympic athletes. Injury rates differ according to age and sport. Upper limb injuries are common. The knowledge gained from this study will inform future injury surveillance studies and the development of prevention strategies in Paralympic sport. The Epidemiology of Injuries at the London 2012 Paralympic Games.

Background In this study we describe (1) the implementation of a novel web-based injury and illness surveillance system (WEB-IISS) for use by a team of physicians at multisport events and (2) the incidence and characteristics of injuries and illness in athletes during the London 2012 Paralympic Games. Methods Overall, 3565 athletes from 160 of the 164 participating countries were followed daily over a 14-day period, consisting of a precompetition period (3 days), and a competition period (11 days) (49 910 athletedays). Daily injury and illness data were obtained from teams with their own medical support (78 teams, 3329 athletes) via the WEB-IISS, and without their own medical support through the London Organising Committee of the Olympic Games and Paralympic Games database (82 teams and 236 athletes). Results There were no differences between incidence rates (IR) of injury and illness, or between the precompetition and competition periods. The IR of injury during the competition period was 12.1/1000 athlete-days, with an incidence proportion (IP) of 11.6% (95% CI 11.0% to 13.3%). Upper limb injuries (35%), particularly of the shoulder (17%) were most common. The IR of illness during the competition period was 12.8/1000 athlete-days (95% CI 12.18 to 1421), with an IP of 10.2%. The IP was highest in the respiratory system (27.4%), skin (18.3%) and the gastrointestinal (14.5%) systems. Conclusions During the competition period, the IR and IP of illness and injury at the Games were similar and comparable to the observed rates in other elite competitions. In Paralympic athletes, the IP of upper limb injuries is higher than that of lower limb injuries and non-respiratory illnesses are more common.

Although most risk factors for volleyball-related shoulder problems are similar to those identified for other overhead sports, there appear to be additional volleyball-specific risk factors that may reflect the biomechanical demands of the sport. An understanding of modifiable risk factors is critical to providing optimal care for overuse injuries and may facilitate future efforts to prevent shoulder problems among volleyball athletes.

The incidence of intravascular uptake during lumbar spinal injection procedures is approximately 8.5%. The route of injection and the age of the patient greatly affect this rate. Absence of flashback of blood upon preinjection aspiration does not predict extravascular needle placement. Contrast-enhanced, fluoroscopic guidance is recommended when doing lumbar spinal injection procedures to prevent inadvertent intravascular uptake of injectate.

Objective.  To describe the epidemiology of injuries at the Sochi 2014 Winter Paralympic Games.  Methods.  A total of 547 athletes from 45 countries were monitored daily for 12 days during the Sochi 2014 Winter Paralympic Games (6564 athlete days). Daily injury data were obtained from teams with their own medical support (32 teams, 510 athletes) and teams without their own medical support (13 teams, 37 athletes) through electronic data capturing systems. \ud Results.  There were 174 total injuries reported, with an injury incidence rate (IR) of 26.5 per 1000 athlete days (95% CI 22.7% to 30.8%). There was a significantly higher IR recorded in alpine skiing/snowboarding (IR of 41.1 (95% CI 33.7% to 49.6%) p=0.0001) compared to cross-country skiing/biathlon, ice sledge hockey or wheelchair curling. Injuries in the shoulder region were the highest single-joint IR (IR of 6.4 (95% CI 4.6% to 8.6%)), although total upper and lower body IR were similar (IR 8.5 vs 8.4 (95% CI 6.4% to 11.1%)). Furthermore, the IR of acute injuries was significantly higher than other types of injury onset (IR of 17.8 (95% CI 14.7% to 21.4%)). \ud Conclusions.  In a Winter Paralympic Games setting, athletes report higher injury incidence than do Olympic athletes or athletes in a Summer Paralympic Games setting. The highest incidence of injury was reported in the alpine skiing/snowboarding sporting category. There was a similar incidence of injury in the upper and lower limbs. The joint with the greatest rate of injury reported was the shoulder joint. Our data can inform injury prevention programmes and policy considerations regarding athlete safety in future Winter Paralympic Games

There is fair evidence supporting TFESIs as superior to placebo for treating radicular symptoms. There is good evidence that TFESIs should be used as a surgery-sparing intervention, and that TFESIs are superior to interlaminar ESIs (ILESIs) and caudal ESIs for radicular pain. In patients with subacute or chronic radicular symptoms, there is good evidence that a single TFESI has similar efficacy as a single transforaminal injection of bupivacaine or saline. Future studies should address the ideal number of injections. While more placebo-controlled trials are needed to conclusively define the role of TFESIs, current studies support their use in the treatment of lumbosacral radicular pain.

Competitive sports for people with disabilities has grown rapidly over the past several decades, and opportunities for participation are increasingly available throughout the spectrum from developmental to elite. The Paralympic Games, seen as the pinnacle sporting event that represents the broader Paralympic Movement, has provided a platform to showcase the abilities of people with disabilities while also serving as a catalyst for disability rights through ensuring integration, equality of opportunity, and accessibility of the built environment. Concurrently, media coverage of the Paralympic Games has led to an increased awareness of opportunities for sport participation for individuals with disabilities and, with it, the adjustment of norms regarding expectations for exercise as a component of preventive health. In addition, there is evidence of the power of sports to stimulate confidence, self-efficacy, and a self-perceived high quality of life for individuals with disabilities above and beyond the basic benefits to cardiometabolic fitness. When taken together, the promotion of health, disability rights, and social integration through sports has the power to transform the lives of those who participate and to further stimulate the expansion of opportunities available to the next generation of athletes with disabilities.

The Injury Surveillance System identified sport injuries in 24% of all athletes participating in the 2010 Winter Paralympic Games. The injury risk was significantly higher than during the 2002 (9.4%) and 2006 (8.4%) Winter Paralympic Games. This may reflect improved data collection systems but also highlights the high risk of acute injury in alpine skiing and ice sledge hockey at Paralympic Games. These data will assist future Organizing Committees with the delivery of medical care to athletes with a disability and guide future injury prevention research.