Description
Pre-pandemic vs pandemic sports injury case presentations to the Sports Medicine department in a tertiary hospital
Chee JN(1), Fong F (2), MC Wang(1), Lee YHD(1)
(1]Department of Orthopaedic Surgery, National University Hospital, Singapore
(2)Yong Loo Lin School of Medicine, National University of Singapore
Introduction
In January 2020, the world grappled with an unprecedented health crisis as the severe acute respiratory syndrome coronavirus (COVID-19) emerged, swiftly becoming a highly infectious respiratory illness. Within two weeks of initial detection, global COVID-19 cases surged 13-fold, prompting the World Health Organisation to declare it a pandemic and a global public health emergency on March 11, 2020 . To mitigate the rapid spread, nations worldwide, including Singapore, implemented lockdown measures where citizens were mandated to stay at home and were only permitted to leave for essential services. The imposed restrictions during the pandemic had broad consequences, notably influencing healthcare systems.
One notable effect was a shift in the demographics of sports-related injuries. With limitations on public activities and facilities, individuals were prompted to adopt homed-based exercises such as bodyweight training and yoga or engage in outdoor activities alone, such as running and cycling(1). This shift in exercise patterns consequently led to a noticeable change in the patterns of sports-related injury (2).
Methods
This study aims to address these gaps by investigating the impact of COVID-19 restrictions on exercise patterns in a normal Asian population. These findings would be valuable in discerning potential future trends in sports-related injuries post-pandemic and to inform resource allocation in tertiary healthcare centres.Study design A retrospective observational study of patients presenting to the Sports Medicine clinic for the first time was conducted in the National University Hospital (NUH), Singapore.
The inclusion criteria were all medical records of 1) first visit patients presenting to our Sports Medicine department for the first time from March 2019– February 2020 and from March 2020– February 2021 and 2) patients who had sustained an injury relating to their sport or exercise. The exclusion criteria were 1) patients who came for follow-up appointments and 2) non-sporting or exercise related injuries such a road traffic accident. Data collection Demographic information on age, race and gender were collected. Injuries were classified according to sport, and were sub-grouped according to anatomical region affected (e.g. shoulder, knee and ankle), classification of injury (e.g. fractures, dislocations, sprains) and time of presentation (e.g. year of presentation, pre-COVID pandemic, during the COVID pandemic and post-COVID pandemic). All information required was deidentified and obtained from the patients’ electronic case records.This study was approved by the Ethics Review Board
Results
From March 2019 to February 2019 (pre-pandemic), there were 1148 sports-related first visits to the Sports Medicine department, of which 757 (65.9%) were male and 391 (34.1%) were female. Subsequently, from March 2020 to February 2021 (pandemic), there were 852 sports-related first visits to the Sports Medicine department, of which 581 (68.2%) were male and 271 (31.8%) were female. The average age of first visit presentations pre-pandemic (27.82) was significantly younger compared to the average age during the pandemic (29.28).
Significantly more injuries were sustained from individual sports like climbing, gym and cycling during the pandemic (p<0.01), and significantly fewer injuries resulted from team sports like football during the pandemic (p<0.01). The pandemic cohort had significantly more ankle, hand and tibia injuries. Interestingly, back injuries were significantly more prevalent during the pandemic year (p<0.01). The pandemic cohort had significantly fewer ACL injuries (p=0.02), knee ligament injuries excluding meniscus (p<0.01), plantar fasciitis (p=0.04) and ankle sprain (p<0.01).
Of note, we again noted that the pandemic cohort had significantly greater back injuries such as back strain (p=0.03) and prolapsed intervertebral discs (p<0.01) when compared against the pre-pandemic cohort. Sports which were significantly associated with risks of back injuries during the univariate analysis were input into the logistic regression analysis. We noted that gym and swimming were associated with significantly higher risks of back injuries compared to all other sports, while football was associated with a significantly lower risk. Sports which were significantly associated with risks of ACL injury during the univariate analysis were input into the logistic regression analysis. We noted that ball sports especially football, basketball and martial arts, were linked to greater risks of ACL injuries (p<0.01). While exercises such as gym, running and were associated with lower risks of ACL injuries.
Discussion
Finally, sports which were significantly associated with risks of shoulder labral injuries during the univariate analysis were input into the logistic regression analysis. Gym and climbing were independently found to result in higher risks of shoulder labral injuries compared to other sports. To control the spread of COVID infections, the Singaporean government implemented lockdown measures from 7 April to 1 June 2020, 16 May to 13 June 2021 and 22 July to 9 August 2021, restricting citizens to only leave their households for essential services (3) Team sports like basketball and football were legally prohibited due to concerns about COVID transmission. To mitigate the negative impact of reduced physical activity(4), the government actively promoted individual sports like running, cycling or home-based gym workouts. These policies likely explain the change in team and individual sports trend observed.
Our study revealed an increase in back injuries during the pandemic. We postulate that this observation can be attributed to beginners adopting gym workouts during the pandemic. Low back pain is one of the most common complaints in patients who weightlift(5). This is often attributed to improper execution of exercises and using excessive weights (6).
This study also observed a decrease in ACL injuries during the pandemic, particularly in ball sports like football and basketball, which are known to carry higher ACL injury risk (7).During the pandemic, there was also a notable increase in shoulder labral injuries, particularly associated with gym workouts and climbing sports. Rynecki et al (8) found that certain modern fitness trends such as high intensity interval training (HIIT) were significantly correlated with an increase in knee, ankle, and shoulder injuries. They hypothesized that the majority of those who were injured because of HIIT were amateurs who did not have sufficient flexibility, mobility, core strength and muscles to perform these exercises. We hypothesized that overhead movements performed by novice individuals in these sports may have contributed to the increase in shoulder labral injuries during the pandemic.
Conclusion
This study examined the impact of the COVID pandemic on sporting injuries, emphasizing the shifts in demographics compared to the pre-pandemic era due to group restrictions. Recognizing these changes are crucial for authorities and healthcare professionals to anticipate future trends and implement effective public health interventions to reduce the occurrence of such injuries.
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