What is an injury? Caithriona Yeomans

What is an injury? On the surface it seems like a simple question. An injury is some kind of physical insult to the body, right? Well what about an overuse injury, where no physical insult has occurred but the athlete is still limited by pain or dysfunction? So is an injury just when we feel pain? Many athletes will tell you that still play with or through pain, so are they injured? I suppose we could define an injury as pain that stops you from playing sport, but what if it only stops you from playing a match and not training? Or stops you training but you can still go to work or do gym training? Still an injury?

Injury surveillance is reliant on clear comprehensive injury definitions, to ensure data are easily compared and reproduced across various surveillance systems, sport settings and level of play. However, the debate about ‘medical attention injuries’, ‘reportable injuries’ or a ‘time-loss injuries’ still continues, even with the publications of consensus guidelines in sports such as Rugby (Fuller et al., 2007), soccer (Fuller et al., 2006) and athletics (Timpka et al., 2014), to name a few. These guidelines can offer a framework and injury definition for many researchers to use, however when collecting data in settings where resources may be limited (amateur sport) or where access to medical professionals may be infrequent (schools/underage/amateur sport), this framework may need to be altered.

Injuries are often split into ‘medical attention’ and ‘time-loss’ injuries, whereby a ‘medical attention’ injury is one that required some form of medical assessment or treatment and a ‘time-loss’ injury is one that results in missed match and/or training time. However, if an athlete sustains an injury that required medical attention but also missed the subsequent match due to this injury, is this a ‘medical attention’ injury or a ‘time-loss’ injury? Is it both?

If the injury is a ‘time-loss’ injury, how much time needs to be lost for it to be a ‘lime-loss’ injury? Some injury surveillance studies in amateur sport may use a ‘match time-loss injury’ definition, whereby only those injuries that result in a player missing one or more matches are counted as an injury. While this may be used when access to medical professionals or club staff is limited only to matches, it only captures a small percentage of all injuries. This definition may also be subject to bias due to unequal breaks between matches, late season matches and match cancellations (Orchard and Hoskins, 2007). A ‘time-loss injury’ definition focusing on number of days absent from match or training following the date of injury may encompass the injuries missed by a ‘match time-loss injury’ definition however, if no medical professionals are available to record the injuries and return to play date between matches then the accuracy and reliability of the data may be queried. Also, in cases where multiple club staff are present recording data, the reliability of this data may be a concern (Hagglund et al., 2005).

The Irish Rugby Injury Surveillance (IRIS) project is collecting injury data from amateur Rugby clubs around Ireland. The IRIS project has implemented a two-tiered system in order to capture all injury data but also ensure accuracy of the data reported. Using a comprehensive bespoke web-based platform, the initial injury may be recorded, regardless of need for medical attention or time lost from match/training activities. This is called the ‘provisional diagnosis’. In Rugby clubs where more than one medical professional may be working, or where there is less frequent contact between medical professionals and the players, the provisional diagnosis may be updated following an assessment by a medical professional, to give a ‘final diagnosis’. Any injury resulting in more than one days absence from Rugby match/training activities is called a ‘time-loss’ injury, with injuries resulting in less than one days absence being called ‘slight injuries’, as per the consensus guidelines (Fuller et al., 2007). In this way, the IRIS project endeavours to capture all injury data, provide accurate injury diagnoses and class injury severity in terms of total number of days absent from Rugby match/training activities.

References:

Fuller, C. W., Ekstrand, J., Junge, A., Andersen, T. E., Bahr, R., Dvorak, J., Hagglund, M., McCrory, P. & Meeuwisse, W. H. 2006. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Br J Sports Med, 40, 193-201.

Fuller, C. W., Molloy, M. G., Bagate, C., Bahr, R., Brooks, J. H., Donson, H., Kemp, S. P., McCrory, P., McIntosh, A. S., Meeuwisse, W. H., Quarrie, K. L., Raftery, M. & Wiley, P. 2007. Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union. Br J Sports Med, 41, 328-31.

Hagglund, M., Walden, M., Bahr, R. & Estrand, J. 2005. Methods for epidemiological study of injuries to professional football players: developing the UEFA model. Br J Sports Med, 39, 340-6.

Orchard, J. & Hoskins, W. 2007. For Debate: Consensus Injury Definitions in Team Sports Should Focus on Missed Playing Time. Clin J Sport Med, 17, 192-196.

Timpka, T., Alonso, J.M., Jacobsson J., Junge, A., Branco, P., Clarsen, B., Kowalski, J., Mountjoy, M., Nilsson, S., Pluim, B., Renstrom, P., Ronsen, O., Steffen, K. & Edourd, P. 2014. Injury and illness definitions and data collection procedures for use in epidemiological studies in Athletics (track and field): Consensus statement. Br J Sports Med, 48, 483-490.

Caithriona is a Physiotherapist and a postgraduate researcher on the IRFU -IRIS Irish Rugby Football Union Injury Surveillance and Prevention project.  Her research interests include Injury Epidemiology, Injury Prevention, Rugby Injuries.  You can contact Caithriona via email at Caithriona.Yeomans@ul.ie or view her profile on LinkedIn                           Caithriona2

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