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Letters to the Editor |
San Francisco, California
Dear Editor:
The article by Dubravcic-Simunjak et al. entitled "The Incidence of Injuries in Elite Junior Figure Skaters" (July/August 2003, pages 511–517) addresses an important but often overlooked group, younger elite figure skaters, and includes both sexes and all three competitive events. Although the authors have obviously applied considerable effort and time to this undertaking, nowhere in the article were we able to find a definition of "injury," that is, criteria used by skaters to report a condition as an injury, thus it is impossible to place this study in the context of others in the literature. Further, unlike many studies, the authors chose to accept an injury from any point in a skater’s career, further complicating any calculation of rates and thus any comparisons with other studies. Therefore the conclusion of "increasing incidence of overuse injuries" should be viewed with caution.
More caution should be employed when considering the recommendations provided in the abstract: "Programs to improve postural alignment, flexibility, and strength, especially during the asynchronous period of bone and soft tissue development, should be instituted to prevent and reduce overuse syndromes." Such programs might be helpful, but this investigation examined none of these issues and thus provides no scientific support for such programs.
Elsewhere in the literature there is also a paucity of scientific evidence supporting programs to "improve postural alignment, flexibility, etc." in the cause of injury prevention. Conventional wisdom would suggest such programs might be beneficial, but scientific support remains lacking.
While it is tempting to offer common-sense suggestions to perceived problems, if we expect the sports world to heed our advice and alter (often time-honored) training and conditioning methods in the name of enhanced safety, we should be assured that the results will be both positive and predictable. That assurance does not yet exist.
Zagreb, Croatia
Maastricht, The Netherlands
Victoria, British Columbia, Canada
We thank Dr. Garrick for his comments on our article. We agree with him that there is a paucity of published articles on this group of figure skaters, and we intended to add to the work in this area of scientific studies as this research was done on the top skaters who represented their countries at World Junior Figure Skating Championships.
As we stated in the introduction section of our article, two types of injuries were investigated. We used the same definition and compared the results of the present study with other studies done by Authorsen et al.,1 Bloch,2 Brock and Striowski,3 Kjaer and Larsson,6 Nikolic et al.,7 and Smith and Ludington.9 Therefore, we believe that our conclusion of an increase of injuries is correct. The acute injuries were defined as injuries occurring during a certain determined and limited time period that cause tissue damage, whereas overuse injuries occur because of microtraumatic tissue damage in which the original cause of the injury cannot be proved and, in most cases, the skaters neither feel or remember the time of initial tissue damage. The skaters, as mentioned in the "Materials and Methods" section, responded to a questionnaire and were assisted by their coaches or team physician, or both, to more clearly distinguish between acute and overuse injuries.
Our conclusion about the preventive effect of stretching, strengthening, and proper postural alignment was not the aim of our study, but to provide some scientific basis for our recommendations, we refer to the work by Dr. Angela Smith10,11 illustrating that improved alignment, flexibility, and strength can prevent anterior knee pain in adolescent elite figure skaters. Similar research and conclusions were also presented in several other published papers, such as from Hartig and Henderson,4 where the authors conclude that the number of lower extremity overuse injuries was significantly lower with increased hamstring flexibility. Hawkins and Metheny5 give the guidelines for developing injury prediction models that may be used in the future to establish safe and effective training guidelines for children. Scott8 provides a framework for physicians, athletes, and coaches to better understand the complexities of training, with the hope of preventing overuse problems.
It is true that in the sports world there is still no assurance of safety but we, as medical doctors, have the obligation to make it as safe as possible for the benefit of the athlete.
REFERENCES
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