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RESEARCH PROJECT : STUDY LEADER : DR CHRISTA JANSE VAN RENSBURG (Cycle injuries during racing/training) Database: Ovid MEDLINE(R) <1996 to November Week 3 2009> Search Strategy: -------------------------------------------------------------------------------- 1 Bicycling/ (3845) 2 Bicycling/in (794) 3 training.mp. (105685) 4 2 and 3 (29) 5 (race$ or racing).tw. (39973) 6 2 and 5 (19) 7 4 or 6 (42) 8 limit 7 to english language (34) 9 from 8 keep 2-3,11,20,28,31 (6) 10 8 not 9 (28) 11 from 10 keep 1-28 (28) *************************** Result <1> Unique Identifier 8947395 Status MEDLINE Authors Dannenberg AL. Needle S. Mullady D. Kolodner KB. Authors Full Name Dannenberg, A L. Needle, S. Mullady, D. Kolodner, K B. Institution Injury Prevention Center, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, USA. Title Predictors of injury among 1638 riders in a recreational long-distance bicycle tour: Cycle Across Maryland. Source American Journal of Sports Medicine. 24(6):747-53, 1996 Nov-Dec. Abstract To assess the incidence of and risk factors for injuries in a group of bicyclists with a well-defined exposure to bicycling, we conducted a prospective study of 1638 recreational bicyclists who rode in the 6-day 339-mile Cycle Across Maryland tour in 1994. The mean age of participants was 39 years (range, 7 to 79), and two-thirds were male. All riders wore helmets. During the tour there were 85 acute traumatic injuries (15.4 per 100,000 person-miles), 76 overuse injuries (13.7 per 100,000 person-miles), and 37 other medical problems (6.7 per 100,000 person-miles). Acute traumatic injuries were associated with a history of racing versus none (relative risk = 2.2, 95% confidence limits = 1.3, 3.7) and with inexperience, no previous Cycle Across Maryland tours versus one or more (relative risk = 1.7, 95% confidence limits = 1.04, 2.8), but not with sex, training, or prior injuries. Inexperience and lack of preride conditioning were risk factors for overuse injuries. The most ! common overuse injuries and medical problems were knee pain, hand or wrist numbness, foot blisters, insect stings and bites, and heat and dehydration. Study results provide exposure-based incidence rates of bicyclist injuries and suggest overuse injuries may be reduced by increased preride conditioning. Publication Type Journal Article. Research Support, U.S. Gov't, P.H.S.. Result <2> Unique Identifier 8638760 Status MEDLINE Authors Kronisch RL. Chow TK. Simon LM. Wong PF. Authors Full Name Kronisch, R L. Chow, T K. Simon, L M. Wong, P F. Institution San Jose State University, California 95192-0037, USA. Title Acute injuries in off-road bicycle racing. Source American Journal of Sports Medicine. 24(1):88-93, 1996 Jan-Feb. Abstract A descriptive study was conducted to investigate injuries sustained at a major off-road bicycling race at Mammoth Mountain, California, July 6 to 10, 1994. A total of 4027 individual starts in five events during the race were reported. Overall, the total number of competitors in the 5 events was 3624, with some cyclists participating in multiple events. Injuries were considered significant if they occurred during competition and prevented the rider from completing the event. Sixteen cyclists had injuries that met these criteria for an overall injury rate of 0.40%. These 16 cyclists had 44 injuries. Abrasions were the most common injury, followed by contusions, lacerations, fractures, and concussions. The mean injury severity score was 3.0 (range, 1 to 5) with 81.2% of the injuries resulting from cyclists going downhill. Injuries were more severe when the riders were thrown from the bicycles (P = 0.03). We observed different mechanisms of injury in various events, suggestin! g that the risk factors for sustaining a traumatic injury may vary according to the type of competition involved. Publication Type Journal Article. Research Support, Non-U.S. Gov't. Result <3> Unique Identifier 11157467 Status MEDLINE Authors Wijesinghe LD. Coughlin PA. Robertson I. Kessel D. Kent PJ. Kester RC. Authors Full Name Wijesinghe, L D. Coughlin, P A. Robertson, I. Kessel, D. Kent, P J. Kester, R C. Institution Department of Vascular and Endovascular Surgery, St James's University Hospital, Leeds, UK. email@example.com Title Cyclist's iliac syndrome: temporary relief by balloon angioplasty. Source British Journal of Sports Medicine. 35(1):70-1, 2001 Feb. Other ID Source: NLM. PMC1724281 Abstract External iliac stenosis due to endofibrosis is a rare condition that predominantly affects top level cyclists. Short term symptomatic relief is reported in an Olympian after percutaneous transluminal angioplasty, which was performed to allow the patient to return to training without delay. Publication Type Case Reports. Journal Article. Result <4> Unique Identifier 9192134 Status MEDLINE Authors Taylor AJ. Tennant WG. Batt ME. Wallace WA. Authors Full Name Taylor, A J. Tennant, W G. Batt, M E. Wallace, W A. Institution Department of Orthopaedics, Queens Medical Centre, Nottingham, United Kingdom. Title Traumatic occlusion of the external iliac artery in a racing cyclist: a cause of ill defined leg pain. Source British Journal of Sports Medicine. 31(2):155-6, 1997 Jun. Other ID Source: NLM. PMC1332622 Abstract Stenosis of the external iliac artery in healthy athletes, although uncommon, has been reported in competition cyclists. A case of a racing cyclist whose chronic vague leg symptoms were incorrectly attributed to L4/5 nerve root irritation is reported. This highlights the importance of clinical vascular testing when assessing ill defined leg pain. The role of trauma as a causative factor in this condition has not been previously documented. Publication Type Case Reports. Journal Article. Result <5> Unique Identifier 12394199 Status MEDLINE Authors Speedy DB. Thompson JM. Rodgers I. Collins M. Sharwood K. Noakes TD. Authors Full Name Speedy, Dale B. Thompson, John M D. Rodgers, Ian. Collins, Malcolm. Sharwood, Karen. Noakes, Timothy D. Institution Department of General Practice and Primary Care, University of Auckland, New Zealand. firstname.lastname@example.org Title Oral salt supplementation during ultradistance exercise.[erratum appears in Clin J Sport Med. 2003 Jan;13(1):67.]. Source Clinical Journal of Sport Medicine. 12(5):279-84, 2002 Sep. Abstract OBJECTIVE: The objective of this study was to determine whether sodium supplementation 1) influences changes in body weight, serum sodium [Na], and plasma volume (PV), and 2) prevents hyponatremia in Ironman triathletes. SETTING: The study was carried out at the South African Ironman triathlon. PARTICIPANTS: Thirty-eight athletes competing in the triathlon were given salt tablets to ingest during the race. Data collected from these athletes [salt intake group (SI)] were compared with data from athletes not given salt [no salt group (NS)]. INTERVENTIONS: Salt tablets were given to the SI group to provide approximately 700 mg/h of sodium. MAIN OUTCOME MEASUREMENTS: Serum sodium, hemoglobin, and hematocrit were measured at race registration and after the race. Weights were measured before and after the race. Members of SI were retrospectively matched to subjects in NS for 1) weight change and 2) pre-race [Na]. RESULTS: The SI group developed a 3.3-kg weight loss (p < 0.0001) ! and significantly increased their [Na] (delta[Na] 1.52 mmol/L; p = 0.005). When matched for weight change during the race, SI increased their [Na] compared with NS (mean 1.52 versus 0.04 mmol/L), but this did not reach statistical significance (p = 0.08). When matched for pre-race [Na], SI had a significantly smaller percent body weight loss than NS (-4.3% versus -5.1%; p = 0.04). There was no significant difference in the increase of [Na] in both groups (1.57 versus 0.84 mmol/L). PV increased equally in both groups. None of the subjects finished the race with [Na] < 135 mmol/L. CONCLUSIONS: Sodium ingestion was associated with a decrease in the extent of weight loss during the race. There was no evidence that sodium ingestion significantly influenced changes in [Na] or PV more than fluid replacement alone in the Ironman triathletes in this study. Sodium supplementation was not necessary to prevent the development of hyponatremia in these athletes who lost weight, indicatin! g that they had only partially replaced their fluid and other losses d uring the Ironman triathlon. Publication Type Clinical Trial. Controlled Clinical Trial. Journal Article. Result <6> Unique Identifier 12011723 Status MEDLINE Authors Kronisch RL. Pfeiffer RP. Chow TK. Hummel CB. Authors Full Name Kronisch, Robert L. Pfeiffer, Ronald P. Chow, Tony K. Hummel, Christopher B. Institution Student Health Center, San Jose State University, One Washington Square, San Jose, CA 95192-0037, USA. Title Gender differences in acute mountain bike racing injuries. Source Clinical Journal of Sport Medicine. 12(3):158-64, 2002 May. Abstract OBJECTIVE: To evaluate injury rates and patterns in off-road bicycle racing, and to compare the findings in male and female cyclists. SETTING: The study was conducted from 1994-2001 at a large off-road bicycling competition held for 4 days each summer at Mammoth Mountain, California. DESIGN: Injured cyclists were evaluated at the first aid station or at the local hospital. Registration data were used to estimate the number of male and female competitors in each race. PARTICIPANTS: Cyclists who sustained an injury during a race and were unable to finish the race due to the injury were included in the study. 22 female subjects and 71 male subjects met the inclusion criteria during the 8-year study period. There were a total of 20,769 race participants during the study period. MAIN OUTCOME MEASURES: Injuries were categorized, and injury rates were calculated. RESULTS: The overall injury rate during the study period was 0.77% (22/2,869) for women versus 0.40% (71/17,900) for m! en (p = 0.01). Fractures were sustained by 45.5% (10/22) of female subjects versus 21.1% (15/71) of male subjects (p = 0.03). Odds ratios indicate that overall, women were 1.94 times more likely than men to sustain an injury and 4.17 times more likely to sustain a fracture. CONCLUSIONS: These data suggest that although participation in this sport is higher among men, the risk of injury is greater for women. Publication Type Journal Article. Result <7> Unique Identifier 10695851 Status MEDLINE Authors Speedy DB. Rogers IR. Noakes TD. Thompson JM. Guirey J. Safih S. Boswell DR. Authors Full Name Speedy, D B. Rogers, I R. Noakes, T D. Thompson, J M. Guirey, J. Safih, S. Boswell, D R. Institution Department of General Practice and Primary Care, University of Auckland, New Zealand. Title Diagnosis and prevention of hyponatremia at an ultradistance triathlon. Source Clinical Journal of Sport Medicine. 10(1):52-8, 2000 Jan. Abstract OBJECTIVE: To evaluate a method of medical care at an ultradistance triathlon, with the aim of reducing the incidence of hyponatremia. DESIGN: Descriptive research. SETTING: New Zealand Ironman triathlon (3.8 km swim, 180 km cycle, 42.2 km run). PARTICIPANTS: 117 of 134 athletes seeking medical care after the triathlon (involving 650 race starters). INTERVENTIONS: A prerace education program on appropriate fluid intake was undertaken. The number of support stations was decreased to reduce the availability of fluid. A body weight measurement before the race was introduced as a compulsory requirement, so that weight change during the race could be included in the triage assessment. An on-site laboratory was established within the race medical tent. MAIN OUTCOME MEASURES: Numbers of athletes and diagnoses, including the incidence of symptomatic hyponatremia (defined as symptoms of hyponatremia in association with a pretreatment plasma sodium concentration [Na] < 135 mmol/L); ! weight changes; and changes in [Na]. RESULTS: The common diagnoses in the 117 athletes receiving attention were exercise- associated collapse (27%), musculoskeletal complaints (26%), and dehydration (12%). There was a significant reduction in the number of athletes receiving medical care for hyponatremia, from 25 of the 114 athletes who received care in 1997 (3.8% of race starters) to 4 of the 117 athletes who received care in 1998 (0.6% of race starters). Mean weight change among athletes in the 1998 race was -3.1 kg, compared with -2.6 kg in 1997. CONCLUSION: A preventive strategy to decrease the incidence of hyponatremia, including education on fluid intake and appropriate placement of support stations, was associated with a decrease in the incidence of symptomatic hyponatremia. Publication Type Comparative Study. Journal Article. Result <8> Unique Identifier 16640947 Status MEDLINE Authors Martinez JM. Authors Full Name Martinez, John M. Institution Coastal Sports and Wellness Medical Center, 4010 Sorrento Valley Boulevard, Suite C, San Diego, CA 92121, USA. email@example.com Title Medical coverage of cycling events. [Review] [29 refs] Source Current Sports Medicine Reports. 5(3):125-30, 2006 May. Abstract Medical coverage of recreational and competitive cycling events requires significant planning and cooperation among the race and medical directors, race officials, and local emergency medical services. The medical team should be proficient in treating minor and self-limiting injuries such as abrasions and minor trauma. The medical team should also have contingency plans for medical emergencies, such as cardiac events and major trauma, that ensure rapid stabilization and transport of the athlete to the appropriate medical facility. Stationary and mobile medical teams may be necessary for proper coverage of the event. Event day communication systems between individual medical staff as well as race officials and local emergency medical services is important to the success of the event. [References: 29] Publication Type Journal Article. Review. Result <9> Unique Identifier 16144585 Status MEDLINE Authors Asplund C. Webb C. Barkdull T. Authors Full Name Asplund, Chad. Webb, Charles. Barkdull, Thad. Institution Eisenhower Army Medical Center, Fort Gordon, GA 30905-5650, USA. firstname.lastname@example.org Title Neck and back pain in bicycling. Source Current Sports Medicine Reports. 4(5):271-4, 2005 Oct. Abstract Neck and back pain are among the most common overuse injuries in cyclists. Bicycle fit, improper equipment, training errors, and individual anatomic factors are important evaluation considerations. By learning how to recognize and treat contributing factors, as well as learning a few simple bike-fitting techniques, physicians can treat and prevent many common problems of this popular activity. Publication Type Journal Article. Result <10> Unique Identifier 12831694 Status MEDLINE Authors Young CC. Authors Full Name Young, Craig C. Institution Department of Orthopaedic Surgery, Division of Sports Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226-0099, USA. email@example.com Title Extreme sports: injuries and medical coverage. [Review] [31 refs] Source Current Sports Medicine Reports. 1(5):306-11, 2002 Oct. Abstract Extreme sports (including in-line skating, snowboarding, mountain bicycling, extreme skiing, rock climbing, indoor tackle football, kickboxing, skateboarding, and ultra-endurance racing) are growing in popularity. Often these sports are designed to expose athletes to greater thrills and risks than are found in traditional sporting activities. Despite this increased risk of injury, athletes competing in these sports often have little or no formal medical coverage. This article reviews what is known about this emerging area of sports medicine to assist physicians in preparing for medical coverage of these athletes and their competitions. [References: 31] Publication Type Journal Article. Review. Result <11> Unique Identifier 14519363 Status MEDLINE Authors Bertoldo U. Nicodemo A. Pallavicini J. Masse A. Authors Full Name Bertoldo, U. Nicodemo, A. Pallavicini, J. Masse, A. Institution 1st Orthopaedic Clinic, Department of Orthopaedics, Traumatology and Occupational Medicine, University of Turin, Turin, Italy. Title Acute bilateral compartment syndrome of the thigh induced by spinning training. [Review] [8 refs] Source Injury. 34(10):791-2, 2003 Oct. Publication Type Case Reports. Journal Article. Review. Result <12> Unique Identifier 12784169 Status MEDLINE Authors Egermann M. Brocai D. Lill CA. Schmitt H. Authors Full Name Egermann, M. Brocai, D. Lill, C A. Schmitt, H. Institution Stiftung Orthopadische Universitatsklinik Heidelberg, Heidelberg, Germany. Title Analysis of injuries in long-distance triathletes. Source International Journal of Sports Medicine. 24(4):271-6, 2003 May. Abstract Triathlon is an individual sport consisting of three disciplines - swimming, cycling and running. Triathlon has changed from a novel appearance to a very popular Olympic sport within the last fifteen years. Nevertheless, there is not sufficient data about injuries in triathlon. The aim of this retrospective survey was to investigate the incidence of injuries according to class of injuries, anatomical sites and disciplines. Relations to age, sex, performance level, training habits and medical care were analysed. Questionnaires were sent to all German speaking participants of the Ironman Europe 2000. With a response rate of 35 %, 656 questionnaires met the inclusion criteria. At least one injury was experienced by 74.8 % (95 %-CI: 71.3-78.1) of all respondents during their active time in triathlon. 51.1 % (95 %-CI: 47.2-55.0) suffered one or more contusion/skin-abrasions, 33.1 % (95 %-CI: 29.5-36.8) muscle- /tendon-injuries, 29.0 % (95 %-CI: 25.5-32.6) ligament-/capsule-injur! ies and 11.9 % (95 %-CI: 9.5-14.6) fractures. Most of the injuries happened during cycling (54.8 % [95 %-CI: 51.9-57.8]) within training sessions. 18.7 % (95 %-CI: 16.4-21.2) of all injuries occurred while the athletes were competing. Considering the low number of competition hours per year, the incidence of injuries during competition was higher than during training session. Significant relations were found considering the age, performance level and weekly training hours of the triathletes. Older athletes sustained more fractures (p = 0.024), high performance athletes suffered more contusions/abrasions (p = 0.003) and muscle- tendon-injuries (p = 0.001) and athletes with a large number of weekly training hours suffered more muscle-tendon-injuries (p = 0.014). To summarize, injuries in triathlon seem to be related to age, performance level and weekly training hours, but not to sex, presence of training coach and medical care. Publication Type Journal Article. Result <13> Unique Identifier 9506798 Status MEDLINE Authors Vleck VE. Garbutt G. Authors Full Name Vleck, V E. Garbutt, G. Institution Clinical Science and Orthopaedics, Staffordshire University, Stoke-on-Trent, UK. Title Injury and training characteristics of male Elite, Development Squad, and Club triathletes. Source International Journal of Sports Medicine. 19(1):38-42, 1998 Jan. Abstract Links between overuse injury prevalence in triathletes training for 1.5km, 40km, 10km triathlon and both intrinsic and extrinsic factors were assessed in 12 Elite, 17 Development and 87 male Club triathletes by a five year retrospective questionnaire. Elite, Development and Club triathletes differed in training mileage, duration and number of workouts but not in overall injury prevalence, distribution, and severity. Overuse injury occurred in 75.0% of male Elite Squad, 75.0% of Development Squad and 56.3% of Club athletes with 1.9-2.9 sites affected. The most common injuries - the achilles tendon (10.3-17.9%), lower back (15.8-17.9%) and knee (14.2-21.9% of injuries) - were also among the most severe. Running injuries accounted for more of the total number of injuries than cycling injuries in Elite (62.1 % vs 34.5%, p<0.05), Development (64.3% vs 25.0%, p<0.05) and Club triathletes (58.7% vs 15.9%, p<0.05). The number of running injuries sustained correlated with triathlon! training distance, cycling distance (p<0.03), swimming distance (p<0.01), number of triathlon workouts (p<0.03) and number of running sessions (p<0.03) within one weeks race training. The number of overuse injuries sustained during cycling correlated with time spent running and cycling. Publication Type Comparative Study. Journal Article. Research Support, Non-U.S. Gov't. Result <14> Unique Identifier 10073627 Status MEDLINE Authors Green BN. Johnson CD. Maloney A. Authors Full Name Green, B N. Johnson, C D. Maloney, A. Institution Palmer Center for Chiropractic Research, Palmer College of Chiropractic West, San Jose, California 94580, USA. Title Effects of altering cycling technique on gluteus medius syndrome. Source Journal of Manipulative & Physiological Therapeutics. 22(2):108-13, 1999 Feb. Abstract OBJECTIVE: We discuss how altering the cycling technique of a cyclist receiving periodic chiropractic care helped in the management of gluteus medius syndrome. CLINICAL FEATURES: A 24-year-old male amateur cyclist had numbness and tingling localized to a small region on the superior portion of the right buttock. The area involved demonstrated paresthesia to light touch sensory evaluation. The cyclist had received chiropractic adjustments 2 days before the onset of the symptoms. One week earlier, the patient began riding a new bicycle with different gearing than his previous one. Manual-resisted muscle testing created soreness in the lumbosacral area and buttocks. Trigger points were identified in the right gluteus medius. Standing lumbar spine flexion was 70 degrees, limited by tight hamstrings. INTERVENTION AND OUTCOME: Because the patient was already receiving periodic chiropractic care, no passive therapy was used. Patient education regarding the difference in gear sele! ction in bicycles of a higher quality was provided. He was instructed to train in lower gears than he had previously used and to maintain a cadence of 70 to 90 revolutions of the pedals per minute. After 2 days, the paresthesia on the right buttock resolved. The trigger points were only mildly tender with minimal residual soreness of the involved muscles. CONCLUSION: Management of gluteus medius syndrome by altering the cadence and gear development for a bicyclist is discussed. Either frank or cumulative injury to the gluteus medius muscle is the typical etiologic factor for this syndrome. Repetitive strain of the patient's gluteus medius muscle as a result of poor cycling technique appeared to be the cause here. Knowledge of bicycle fitting, training techniques, and bicycle mechanics appeared necessary to resolve the problem. Publication Type Case Reports. Journal Article. Research Support, Non-U.S. Gov't. Result <15> Unique Identifier 12723674 Status MEDLINE Authors Burns J. Keenan AM. Redmond AC. Authors Full Name Burns, Joshua. Keenan, Anne-Maree. Redmond, Anthony Charles. Institution School of Exercise and Health Sciences, University of Western Sydney, NSW, Australia. firstname.lastname@example.org Title Factors associated with triathlon-related overuse injuries. Source Journal of Orthopaedic & Sports Physical Therapy. 33(4):177-84, 2003 Apr. Abstract STUDY DESIGN: Descriptive correlational investigation. OBJECTIVES: To assess the incidence of, and potential risk factors associated with, overuse injury in triathlon. BACKGROUND: The sport of triathlon is rapidly increasing in popularity with a concomitant rise in the prevalence of injuries sustained by triathletes. METHODS AND MEASURES: The training and injury patterns of 131 triathletes were surveyed over a 10-week prospective period during the triathlon competition season. A complementary retrospective 6-month analysis of training history and prior overuse injuries was conducted. RESULTS: Fifty percent of triathletes sustained an injury in the 6-month preseason at an injury exposure rate of 2.5 per 1000 training hours. Thirty-seven percent were injured during the 10-week competition season at an injury exposure rate of 4.6 per 1000 training hours. Overuse accounted for 68% of preseason and 78% of competition season injuries reported. Increased years of triathlon experi! ence, high running mileage, history of previous injury, and inadequate warming-up and cooling-down regimes appeared to have individual associations with injury incidence. When interactions were included in a multiple logistic regression model, increasing years of triathlon experience was the most significant predictor of preseason injury risk and a previous history of injury and high preseason running mileage increased the risk of injury during the competition season. CONCLUSIONS: The results indicate that in assessing triathletes, a full training and competition history is required by the sports clinician for a comprehensive assessment of the factors that may contribute to overuse injury. Publication Type Journal Article. Result <16> Unique Identifier 9440040 Status MEDLINE Authors Cipriani DJ. Swartz JD. Hodgson CM. Authors Full Name Cipriani, D J. Swartz, J D. Hodgson, C M. Institution Department of Physical Therapy, Medical College of Ohio, Toledo 43699-0008, USA. Title Triathlon and the multisport athlete. [Review] [49 refs] Source Journal of Orthopaedic & Sports Physical Therapy. 27(1):42-50, 1998 Jan. Abstract The sport of triathlon is a rapidly growing arena for athletic competition and training. Men and women of various fitness backgrounds have become involved in this sport that involves the disciplines of swimming, cycling, and running. Training for multiple sports has the advantages of providing the athlete with a variety of means of maintaining fitness in the event of an injury. On the other hand, multisport training may also contribute to a special category of injuries, those related to the cumulative effects of cross-training. The purpose of this paper is to provide a review of the literature regarding triathlon training and injuries. A survey of a local triathlon club regarding the incidence of injuries is presented, and comparisons are made with previously published surveys. Finally, this paper attempts to outline the training conditions of the triathlete and to provide readers with strategies for injury management. [References: 49] Publication Type Journal Article. Review. Result <17> Unique Identifier 15712500 Status MEDLINE Authors Shaw T. Howat P. Trainor M. Maycock B. Authors Full Name Shaw, T. Howat, P. Trainor, M. Maycock, B. Institution Child Health Promotion Research Unit, Edith Cowan University, Perth, Western Australia. Title Training patterns and sports injuries in triathletes. Source Journal of Science & Medicine in Sport. 7(4):446-50, 2004 Dec. Abstract Sports-related injuries are a significant health problem within Australia, and constitute a national health priority. There is limited Australian research data available on factors that contribute to triathlon injuries, and in particular on how training patterns relate to injury risk. This study examined the association between training patterns and injury in mostly non-elite triathletes. A cross- sectional survey of 258 triathletes completed a questionnaire that focused on injuries they had sustained during the previous three triathlon seasons. Statistical associations were found between hours of training and sustaining an injury. These associations were U shaped, with those triathletes training at low levels and at high levels more likely to sustain an injury. The results suggest that, for non-elite triathletes, the likelihood of sustaining an injury is least when training for a total of 8 to 10 hrs per week, specifically cycling for five to six hrs and running for three ! to four hrs weekly. Time spent on swimming training does not appear to affect injury risk. This research is seen as a contribution towards assisting triathletes in the planning of training programs aimed at reducing the risk of injury. Publication Type Journal Article. Result <18> Unique Identifier 17369804 Status MEDLINE Authors Korsten-Reck U. Rocker K. Schmidt-Trucksass A. Schumacher YO. Striegel H. Rimpler H. Dickhuth HH. Authors Full Name Korsten-Reck, U. Rocker, K. Schmidt-Trucksass, A. Schumacher, Y O. Striegel, H. Rimpler, H. Dickhuth, H H. Institution Medical Clinic, Department of Rehabilitative and Preventive Sports Medicine, University of Freiburg, Freiburg, Germany. korsten- email@example.com Title External iliac artery occlusion in a young female cyclist. Source Journal of Sports Medicine & Physical Fitness. 47(1):91-5, 2007 Mar. Abstract After 8 years of high performance training in mountain biking, a top female athlete, aged 23, first complained of diffuse, exercise- induced pain in both thighs. Over a period of the next 4 years, a slight but continuous reduction in her performance was observed, despite having maintained her training regime during the first 2 years. Gradually, pain increased, at last occurring even when she climbed a few stairs. This led to a clinical, echo-Doppler, MR-angiographic and DS-angiographic examination, which showed a complete occlusion of the right iliac external artery with good collateralisation. The left external iliac artery evidenced only small intravascular lesions. Surgical treatment (endarterectomy plus patch angioplasty) eliminated the pain completely. Except for a lipoprotein (a) of 114 mg/dL, no other significant risk factors were found. The influence of a genetic (heterocygotic) low APC-ratio of 1.6 and free protein S of 53% is unclear. This is a typical case of a d! elayed diagnosis in an athlete. A complete occlusion of an external iliac artery is extremely seldom in young in female athletes. With no indication of a general atherosclerotic or inflammatory process nor congenital abnormalities, an exercise-induced, chronic traumatisation may have caused this pathological condition. Publication Type Case Reports. Journal Article. Result <19> Unique Identifier 9509830 Status MEDLINE Authors Abraham P. Chevalier JM. Saumet JL. Authors Full Name Abraham, P. Chevalier, J M. Saumet, J L. Institution Laboratoire d'Explorations Vasculaires et de Medicine du Sport, Centre Hospitalier Universitaire, Angers, France. Title External iliac artery endofibrosis: a 40-year course. Source Journal of Sports Medicine & Physical Fitness. 37(4):297-300, 1997 Dec. Abstract External iliac artery endofibrosis is a rare disease affecting mainly highly trained cyclists. As the disease has only recently been described, the long term spontaneous evolution of external iliac artery endofibrosis is not known. We report a suspected case of forty-year spontaneous evolution of endofibrosis in a former competition cyclist. The results of this isolated original report suggest, as we intuitively presumed, that the lesions may stabilise when intensive training is stopped. Therefore, when no symptoms are noted on usual daily activity or submaximal exercise, surgery should not be performed. Surgery should only be considered, at the request of the subjects to allow them to continue competing. Publication Type Case Reports. Journal Article. Result <20> Unique Identifier 18063715 Status MEDLINE Authors Wanich T. Hodgkins C. Columbier JA. Muraski E. Kennedy JG. Authors Full Name Wanich, Tony. Hodgkins, Christopher. Columbier, Jean-Allain. Muraski, Erika. Kennedy, John G. Institution Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA. Title Cycling injuries of the lower extremity. [Review] [32 refs] Source Journal of the American Academy of Orthopaedic Surgeons. 15(12):748-56, 2007 Dec. Abstract Cycling is an increasingly popular recreational and competitive activity, and cycling-related injuries are becoming more common. Many common cycling injuries of the lower extremity are preventable. These include knee pain, patellar quadriceps tendinitis, iliotibial band syndrome, hip pain, medial tibial stress syndrome, stress fracture, compartment syndrome, numbness of the foot, and metatarsalgia. Injury is caused by a combination of inadequate preparation, inappropriate equipment, poor technique, and overuse. Nonsurgical management may include rest, nonsteroidal anti-inflammatory drugs, corticosteroid injection, ice, a reduction in training intensity, orthotics, night splints, and physical therapy. Injury prevention should be the focus, with particular attention to bicycle fit and alignment, appropriate equipment, proper rider position and pedaling mechanics, and appropriate training. [References: 32] Publication Type Journal Article. Review. Result <21> Unique Identifier 8933484 Status MEDLINE Authors Kronisch RL. Pfeiffer RP. Chow TK. Authors Full Name Kronisch, R L. Pfeiffer, R P. Chow, T K. Institution Student Health Service, San Jose State University, CA, USA. Kronisch@email.sjsu.edu Title Acute injuries in cross-country and downhill off-road bicycle racing. Source Medicine & Science in Sports & Exercise. 28(11):1351-5, 1996 Nov. Abstract This study was conducted to investigate injury patterns at three major off-road bicycle races in the Western United States in 1995. All cyclists forced out of the cross-country (CC) and downhill (DH) competitions due to injury were examined and interviewed. The overall injury rates were 0.49% (20/4074) for the CC and 0.51% (11/2158) for the DH event. In the CC there were 0.37 injured cyclists for every 100 h of racing time versus 4.34 injured cyclists/100 h in the DH (P = 0.01). Injury rates in the CC were higher for women than for men (1.05% vs 0.40%, P = 0.04; 0.75/100 h vs 0.31/100 h, P = 0.01). Injured CC cyclists who fell forward over their handlebars had higher mean injury severity scores (3.0 vs 1.3, P = 0.01) and required more emergency room visits (6/100 vs 1/10, P = 0.02) than cyclists who fell off their bicycles (5/6 vs 5/14, P = 0.05) and were taken to the hospital (4/6 vs 3/14, P = 0.05) more often than men. These data suggest that 1) the risk of being injured! during a race is similar in the CC And DH events, 2) the long-term risk may be greater to DH racers than to CC competitors, 3) the severity of injury is greater when a CC cyclists falls forward off the bicycle, and 4) women CC competitors are more likely to fall forward off their bicycles and be injured than men. Publication Type Journal Article. Research Support, Non-U.S. Gov't. Result <22> Unique Identifier 17112197 Status MEDLINE Authors Villavicencio AT. Burneikiene S. Hernandez TD. Thramann J. Authors Full Name Villavicencio, Alan T. Burneikiene, Sigita. Hernandez, Theresa D. Thramann, Jeff. Institution Boulder Neurosurgical Associates, Boulder, Colorado 80304, USA. firstname.lastname@example.org Title Back and neck pain in triathletes. Source Neurosurgical Focus. 21(4):E7, 2006. Abstract OBJECT: As the sport of triathlon has continued to grow, increasing numbers of triathletes have presented in the neurosurgery clinics with various spinal disorders. This epidemiological study was undertaken to establish the lifetime incidence of neck and back pain, to gauge the prevalence of discogenic pain, and to identify risk factors among triathletes in the Boulder, Colorado, area. METHODS: A live online questionnaire was developed that was used to collect information about physical characteristics, training habits, athletic status, number of races completed, and back pain among triathletes. The incidence of cervical and/or lumbar discogenic back pain was defined according to the duration of symptoms for the most recent pain episode. The lifetime incidence of low-back pain was 67.8%, with 23.7% of cases possibly being discogenic in origin. The number of triathlons in which the respondents had participated and the presence of previous sports-related injuries were predic! tive of low-back pain (p = 0.02 and p < 0.00001, respectively). The lifetime incidence of neck pain was 48.3%, with 21.4% of cases being consistent with intervertebral disc involvement. The number of previous sports-related injuries was predictive of neck pain (p < 0.00001), and a strong tendency toward neck pain was observed for athletes with more total years of participation in sports (p = 0.06). CONCLUSIONS: The two main risk factors for long-term spinal problems include sports-related injuries and overuse. The study results definitely support the influence of both mechanisms for low-back pain. Neck pain was associated with an injury event, and a strong (although not statistically significant) tendency toward neck pain was observed in respondents with overuse injuries. Publication Type Journal Article. Research Support, Non-U.S. Gov't. Result <23> Unique Identifier 16952752 Status MEDLINE Authors Strock GA. Cottrell ER. Lohman JM. Authors Full Name Strock, Gregory A. Cottrell, Erika R. Lohman, James M. Institution Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN 46202, USA. email@example.com Title Triathlon. [Review] [49 refs] Source Physical Medicine & Rehabilitation Clinics of North America. 17(3):553-64, 2006 Aug. Abstract From its roots in San Diego to its Olympic debut in Sydney in 2000, triathlon has emerged as a popular sport with a wide variety of participants. Because of the nature of the sport, excessive training resulting in overuse injuries is common. Triathlon injuries can also be unique from the individual sports involved in that they are attributed to a cumulative effect of multi-sport training. Because many triathletes have not grown up participating in the individual sports, biomechanics in each of the disciplines must also be considered as a source of injury. Nutrition and environmental factors and the role that they play in the endurance athlete should also not be overlooked. The sport of triathlon is rapidly growing, and the ability to recognize the unique aspects of these injuries can help the multisport athlete to train properly and be healthier and more successful. [References: 49] Publication Type Journal Article. Review. Result <24> Unique Identifier 10081053 Status MEDLINE Authors Conti-Wyneken AR. Authors Full Name Conti-Wyneken, A R. Institution Department of Physical Medicine and Rehabilitation, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, USA. Title Bicycling injuries. [Review] [16 refs] Source Physical Medicine & Rehabilitation Clinics of North America. 10(1):67-76, 1999 Feb. Abstract The severity of injuries secondary to bicycling range from the pain and nuisance of skin abrasions to life-threatening brain injuries. For most injuries, the key to treatment and prevention is careful assessment of bike fit and training techniques. In general, the treatment of musculoskeletal and neuropathic lesions should follow sound, physiatric treatment principles. Clearly, all clinicians who treat bicyclists have a professional responsibility to educate them on the use of helmets and safe riding rules. [References: 16] Publication Type Journal Article. Review. Result <25> Unique Identifier 12406178 Status MEDLINE Authors McCoy CA. Authors Full Name McCoy, Carrie A. Institution Department of Nursing, Northern Kentucky University, Highland Heights 41099, USA. firstname.lastname@example.org Title Development and pilot testing of a bicycle safety questionnaire for adult bicyclists. Source Public Health Nursing. 19(6):440-50, 2002 Nov-Dec. Abstract Most deaths associated with bicycle riding are reported in those over the age of 16 and the highest death rate per million trips is reported in those over the age of 50, yet most efforts to reduce deaths among bicycle riders have focused on children. The purpose of this study was to pilot test a new instrument designed to assess knowledge of bicycle laws and perception of risk related to specific host behaviors and agents of injury. A pilot study using a descriptive correlational design was conducted among a convenience sample of 104 adult bicycle riders. A 25-item questionnaire was administered to participants (10 knowledge items, 15 belief items). There were no significant differences in total knowledge or belief score for gender, age group, riding frequency, education, or formal bicycle training. Significant differences were found for responses to individual items on both scales. Psychometric testing indicated that items on the knowledge scale were independent. Psychome! tric testing on the belief scale suggested three underlying constructs measuring beliefs about riding behavior, agents of injury, and user burden. Bicycle riders with previous safety training had significantly different scores on the riding behavior and user burden subscales. Publication Type Journal Article. Validation Studies. Result <26> Unique Identifier 16163995 Status MEDLINE Authors Carmont MR. Daynes R. Sedgwick DM. Authors Full Name Carmont, M R. Daynes, R. Sedgwick, D M. Institution The Belford Hospital, Fort William. email@example.com Title The impact of an extreme sports event on a district general hospital. Source Scottish Medical Journal. 50(3):106-8, 2005 Aug. Abstract BACKGROUND: Extreme sports events are increasing in popularity, particularly in mountainous areas throughout Great Britain. Emergency medical care for these events is usually provided by voluntary organisations, providing event side first aid and referring patients to nearby District General Hospitals. The Fort William Mountain Bike Race is part of the UCI World Cup Series: 173 competitors racing in cross country, downhill and 4X events. The Belford Hospital provides year round medical care for the Lochaber community, which frequently swells during the tourist season. The hospital has 8300 new attendances per annum, 35 patient reviews per 24 hrs. METHODS AND RESULTS: We have reviewed the impact of the event on the local hospital. In total 52 riders reported 61 injuries. The hospital treated 24q (14%) riders. Retrospective analysis of attendances has revealed 19 riders attended on race days, increasing attendees by up to 28%. 46% of injured riders were seen at the A &E depa! rtment, 1 rider requiring admission for observation and 1 rider required inter-hospital transfer Injury patterns (knee 20%, hand/wrist 18% and shoulder 18%) were similar to other reported series. CONCLUSIONS: We believe that extreme sports events can have considerable impact on small district general hospitals. Additional triage and staffing resources should be utilised and event organisers should anticipate the additional problems they present to the local community. District General Hospitals continue to provide a substantial contribution to the provision of health care for extreme sports within the UK. Publication Type Comparative Study. Journal Article. Result <27> Unique Identifier 12076178 Status MEDLINE Authors Kronisch RL. Pfeiffer RP. Authors Full Name Kronisch, Robert L. Pfeiffer, Ronald P. Institution Student Health Center, San Jose State University, San Jose, California 95192, USA. Title Mountain biking injuries: an update. [Review] [62 refs] Source Sports Medicine. 32(8):523-37, 2002. Abstract This article reviews the available literature regarding injuries in off-road bicyclists. Recent progress in injury research has allowed the description of several patterns of injury in this sport. Mountain biking remains popular, particularly among young males, although sales and participation figures have decreased in the last several years. Competition in downhill racing has increased, while cross-country racing has decreased somewhat in popularity. Recreational riders comprise the largest segment of participants, but little is known about the demographics and injury epidemiology of noncompetitive mountain cyclists. Most mountain bikers participating in surveys reported a history of previous injuries, but prospective studies conducted at mountain bike races have found injury rates of <1%. The most common mechanism of injury involves a forward fall over the handlebars, usually while riding downhill, which can result in direct trauma to the head, torso and upper extremitie! s. A variety of factors can be associated with this type of fall, including trail surface irregularities, mechanical failures and loss of control. In mountain bike racing the risk of injury may be higher for women than men. Minor injuries such as abrasions and contusions occur frequently, but are usually of little consequence. Fractures usually involve the torso or upper extremities, and shoulder injuries are common. Head and face injuries are not always prevented by current helmet designs. Fatal injuries are rare but have been reported. Improvements in safety equipment, rider training and racecourse design are suggested injury prevention measures. The authors encourage continued research in this sport. [References: 62] Publication Type Journal Article. Review. Result <28> Unique Identifier 9587180 Status MEDLINE Authors Thompson DC. Patterson MQ. Authors Full Name Thompson, D C. Patterson, M Q. Institution Harborview Injury Prevention and Research Center, University, Washington, Seattle, USA. firstname.lastname@example.org Title Cycle helmets and the prevention of injuries. Recommendations for competitive sport. Source Sports Medicine. 25(4):213-9, 1998 Apr. Abstract The scientific evidence that bicycle helmets protect against head, brain and facial injuries has been well established by 5 well designed case-control studies. Additional evidence of helmet effectiveness has been provided from time series studies in Australia and the US. Bicycle helmets of all types that meet various national and international standards provide substantial protection for cyclists of all ages who are involved in a bicycle crash. This protection extends to crashes from a variety of causes (such as falls and collisions with fixed and moving objects) and includes crashes involving motor vehicles. Helmet use reduces the risk of head injury by 85%, brain injury by 88% and severe brain injury by at least 75%. Helmets should be worn by all riders whether the cyclist is a recreational rider or a serious competitor engaged in training or race competition. The International Cycling Federation (ICF) should make the use of helmets compulsory in all sanctioned races. Publication Type Journal Article. Meta-Analysis.