Runners who had COVID-19 more likely to get an injury

NewsBot · Mar 8, 2021

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Increased Incidence of Injury Among Runners With COVID-19
Brett Toresdahl, MD
AMSSM Mtg

Purpose: Coronavirus disease 2019 (COVID-19) impacts multiple organ systems beyond the pulmonary system. Whether and how COVID-19 affects the musculoskeletal system remain unknown but could have implications for injury risk associated with exercise and sports.

Methods: An electronic survey was distributed from July 15, 2020 to September 1, 2020 by AMSSM members who serve as race medical directors, New York Road Runners, ASICS North America and through social media. The inclusion criteria were runners 18 years or older who had participated in at least one race (running or triathlon) of any distance in 2019.

Results: A total of 2278 runners participated of which the average age was 44.7 (SD 12.2), 56% were female and the median number of races completed in 2019 was 6 (interquartile range 3-10). There were 123 of 2060 (5.6%) runners who self-reported having COVID-19; 100 (81%) reported their diagnosis was from labs results (PCR or antibodies) and 23 reported being diagnosed by a medical professional. Since March 2020, 454 of 2089 (22%) reported an injury that prevented running for at least 1 week. In a logistic regression that included age, sex, number of races in 2019 and weekly mileage prior to March 2020, runners who had lab-confirmed or clinically diagnosed COVID-19 had a higher incidence of injury compared to those who did not have COVID-19, 30.9% versus 21.3% (odds ratio 1.66, 95% confidence interval 1.11-2.47, P = 0.01).

Conclusions: In this cohort of runners, injuries were more often reported by those with lab-confirmed or clinically diagnosed COVID-19 compared to those who did not have COVID-19. Given the limitations of the study design, any direct role of COVID-19 in the pathophysiology of injuries among runners remains unclear. For example, returning to running following detraining during acute illness could predispose a runner to injury.

Significance: As the breadth of clinical manifestations of COVID-19 becomes better understood, direct and indirect musculoskeletal sequelae should be investigated, including risk of exercise and sports-related injury.
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NewsBot · Mar 8, 2021

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NewsBot · Jun 29, 2021

Training Behaviors in Active Runners During the COVID-19 Pandemic
Aubrey Armento, MD
Source

Purpose: The effects of stay-at-home orders and lifestyle changes associated with the COVID-19 pandemic on running athletes are not well understood. The aim of the study was to assess training behaviors in active runners before and during the COVID-19 pandemic.

Methods: Participants included runners from a trail race series who participated in a study in the fall of 2019 and agreed to be contacted for 1-year follow-up. A questionnaire was sent via email to all eligible participants, which asked about training and weight changes since the start of stay-at-home orders in March 2020.

Results: A total of 39 participants (68% female; mean age 40 ± 10) completed the follow-up questionnaire. We found 38% of the group reported running less during the pandemic compared to the previous year, while 36% reported running the same amount as before the pandemic (average = 3.7 ± 1.6 d/wk during COVID-19). Use of a mask/face-covering when running outdoors was reported in 41% of the group. 46% participated in at least one virtual race and 38% in at least one in-person race during the pandemic. Almost half of the group (44%) reported no change in their weight during the pandemic, with 31% stating they had lost weight and 23% stating they had gained weight. 28% reported they worried more about their weight since the start of the pandemic.

Conclusions: Over a third of our active running population reported running less since the start of the COVID-19 pandemic. A similar percentage of participants experienced weight loss, with almost one third reporting more worry about their weight during the pandemic. Mask/face-covering use while running outdoors was common but not universal. Virtual racing appears to be a popular alternative to in-person racing during the pandemic.

Significance: Understanding how training behaviors may change during the COVID-19 pandemic is important to promote the health and well-being of all athletes, including runners.
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NewsBot · Jul 1, 2021

Changes in Training, Lifestyle, Psychological and Demographic Factors, and Associations With Running-Related Injuries During COVID-19
Hillary H. Holmes et al
Front. Sports Act. Living, 07 June 2021

The primary purpose of this study was to examine how the type and magnitude of changes in running behavior, as a consequence of COVID-19 pandemic restrictions, influence running-related injuries. Secondarily, we aimed to examine how lifestyle and psychosocial well-being measures may influence running behavior change. An online survey was advertised to individuals over the age of 18 that currently run or have previously participated in running for exercise. The survey questions examined injury history and new injuries sustained during COVID-19 restrictions, as well as changes related to training behavior changes, training environment changes, social behaviors, and psychosocial well-being. Changes reflected differences in running behaviors prior to COVID-19 restrictions (1 month prior to COVID-19 restrictions being imposed) and during COVID-19 restrictions (May 5 to June 10, 2020). A total of 1,035 runners were included in the analysis. Current injuries sustained during COVID-19 occurred in 9.5% of the runners. Injured runners made a greater number of total changes (p = 0.031) as well as training-related (p = 0.042) and environment-related (p = 0.017) changes compared with uninjured runners. A significant relationship was found between injury and those that reported less time to exercise to changes in work environment (p = 0017). This study highlights the multi-dimensional nature of running-related injuries and the need to consider the interaction of multiple changes in running behavior, rather than isolating single factors. Greater understanding of the underlying causes of running-related injuries can help reduce the risk of future injury.
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NewsBot · Jan 3, 2022

Increased Incidence of Injury Among Runners With COVID-19
Brett G. Toresdahl, MD*, James N. Robinson, MD, Stephanie A. Kliethermes, PhD, ...
Sports Health: A Multidisciplinary Approach December 14, 2021

Background:
Coronavirus disease 2019 (COVID-19) affects multiple organ systems. Whether and how COVID-19 affects the musculoskeletal system remains unknown. We aim to assess the association between COVID-19 and risk of injury.

Hypothesis:
Runners who report having COVID-19 also report a higher incidence of injury.

Study Design:
Cross-sectional study.

Level of Evidence:
Level 4.

Methods:
An electronic survey was distributed from July through September 2020, by New York Road Runners, ASICS North America, race medical directors, and through social media. Inclusion criteria were runners 18 years or older who had participated in ≥1 race (running or triathlon) in 2019.

Results:
A total of 1947 runners participated and met inclusion criteria. Average age was 45.0 (SD, 12.2) years and 56.5% were women. A total of 123 (6.3%) runners self-reported having COVID-19; 100 (81%) reported their diagnosis was from a laboratory test (polymerase chain reaction or antibody) and 23 reported being diagnosed by a medical professional without confirmatory laboratory testing. Since March 2020, 427 (21.9%) reported an injury that prevented running for at least 1 week, including 38 of 123 (30.9%) who self-reported having COVID-19 and 389 of 1435 (21.3%) who did not report having COVID-19 (P = 0.01). After adjusting for age, sex, the number of races in 2019, and running patterns before March 2020, runners who self-reported a diagnosis of COVID-19 had a higher incidence of injury compared with those who did not (odds ratio, 1.66; 95% CI, 1.11-2.48; P = 0.01).

Conclusion:
Injuries were more often self-reported by runners with laboratory-confirmed or clinically diagnosed COVID-19 compared with those who did not report COVID-19. Given the limitations of the study, any direct role of COVID-19 in the pathophysiology of injuries among runners remains unclear.

Clinical Relevance:
Direct and indirect musculoskeletal sequelae of COVID-19 should be further investigated, including the risk of exercise- and sports-related injury after COVID-19.
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NewsBot · Mar 24, 2022

Athletes competing after COVID-19 pandemic were at higher risk for injury

NewsBot · Jun 6, 2022

Effect of COVID-19 on Injury Rates and Timing in the National Football League
Ali M. Omari, MD, Ryan W. Paul, BS, Brian Fliegel, DO, ...
Orthopaedic Journal of Sports Medicine June 2, 2022

Background:
The coronavirus 2019 (COVID-19) pandemic resulted in the cancellation of the 2020 National Football League (NFL) preseason and a decreased preseason roster size. The effect of this disruption on athlete injury rates is unknown.

Purpose/Hypothesis:
The purpose was to quantify the rates of anterior cruciate ligament (ACL), Achilles tendon, and hamstring tendon injuries in NFL players before and after the COVID-19 pandemic. We hypothesized that injury rates in the 2020 season would be higher than those seen prepandemic.

Study Design:
Descriptive epidemiology study. Level of evidence, 4.

Methods:
An online search using publicly available data was carried out to identify all NFL players who sustained an ACL, Achilles tendon, or hamstring tendon injury between April 1, 2017, and March 31, 2021. Data collected included player characteristics as well as career and season of injury workloads.

Results:
The number of Achilles tendon (27 vs 20; P = .024) and hamstring tendon (186 vs 149; P < .001) injuries, respectively, in the 2020 NFL season were significantly higher than the average of the 2017 to 2019 seasons. However, the number of ACL injuries sustained remained constant (43 vs 46; P = .175). More than half (52.9%) of ACL injuries in the 2017 to 2019 seasons occurred in the preseason, while most of the injuries (34.9%) in the 2020 season occurred in weeks 1 to 4. There was no player characteristic or career workload variable collected that was significantly different for players who sustained an ACL, Achilles tendon, or hamstring tendon injury in the 2020 NFL season compared with the 2017 to 2019 seasons.

Conclusion:
In the 2020 NFL season, the number of Achilles tendon and hamstring tendon injuries rose while the number of ACL injuries remained constant compared with the 2017 to 2019 seasons. Injuries that occurred during the first 4 games of the 2020 NFL season were consistent, with higher rates of injuries seen in the preseason in previous years
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NewsBot · Jun 11, 2022

Impact of COVID on Sports Injury Patterns, Changes in Mental Well-Being, and Strategies to Prepare for Future Pandemics in Sport
Vincent, Heather K. PhD, FACSM; Patel, Shammi DO; Zaremski, Jason L. MD, FACSM
Current Sports Medicine Reports: June 2022 - Volume 21 - Issue 6 - p 196-204

This review describes the available evidence of the acute respiratory syndrome coronavirus 2 (SARS-CoV-2, referred to COVID-19) pandemic on musculoskeletal injury patterns and prevalence in athletes. A brief overview of the epidemiology of COVID-19 and prevalence in active populations from youth through professional are provided. Responses to COVID-19 regarding sport participation at regional, national, and international organizations are summarized. Downstream effects of complete or partial training shutdown on injury risk and mental health are discussed. Strategies to maintain athletic potential and overall well-being include maintaining safe access to training facilities and resources, implementation of injury prevention programs, organization of athlete support networks, and incorporation of resilience and coping training.
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NewsBot · Jun 23, 2022

Subsequent Musculoskeletal Injury Incidence Are Similar Between General Infection and COVID-19 among High School Athletes in the Unites States Despite Higher Illness Incidence During Academic years 2019-2020 and 2020-2021
Ellen Shanley, Charles A. Thigpen, Albert Prats-Uribe, Tyler Norhen, Trey Staley, Garrett S. Bullock
Journal of Orthopaedic & Sports Physical Therapy

Objective
1) Describe overall illness, and COVID-19-specific illness in high school athletes in the 2019-2020 and 2020-2021 academic school years; and 2) describe and assess the risk of musculoskeletal injury following general infection, and after COVID-19.

Design
Ecological study

Methods
High schools (6 states; 176 high schools) were matched between the 2019-2020 and 2020-2021 academic school years, based on 2020-2021 high school sport participation. Illness and injury data were collected from the high school athletic trainers. Illness was stratified by overall illness, general infection, and COVID-19. Injuries following moderate or severe infections or COVID-19 were recorded. Illness and injury incidence rate per 100 athletes per year with 95% confidence intervals (95% CI) were calculated. Negative binomial models comparing injury following general infections and COVID-19 infections were calculated.

Results
98,487 and 72,521 athletes participated in the 2019-2020 and 2020-2021 years. Illness incidence rate was less in the 2019-2020 [0.30 (95% CI: 0.27-0.34)] than 2020-2021 [1.1 (1.0-1.2)] year, resulting in a difference of 0.8 (95% CI: 0.7, 0.9). COVID-19 incidence rate was 0.52 (0.47-0.58) in the 2020-2021 year. Injury following general infection incidence rate was 27.9 injuries (21.4-34.5) per 100 athletes in 2019-2020, and 22.5 injuries (19.3-25.7) per 100 athletes in 2020-2021. There was no difference in injury risk following general infection and COVID-19 [Rate Ratio: 1.2 (95% CI: 0.7-2.4)].

Conclusions
The incidence rate for all illnesses in high school athletes was slightly (0.8) greater in the 2020-2021 academic compared to the 2019-2020 year. Most of the incidence increase was due to infections and COVID-19. Subsequent injury incidence following moderate and severe infections were similar between years and between general infections and COVID-19.
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NewsBot · Jun 26, 2022

Resuming Training in High-Level Athletes After Mild COVID-19 Infection: A Multicenter Prospective Study (ASCCOVID-19)
Laurent Chevalier, Hubert Cochet, Saagar Mahida, Sylvain Blanchard S, Antoine Benard, Tanguy Cariou, Soumaya Sridi-Cheniti, Samy Benhenda, Stéphane Doutreleau, Stéphane Cade, Sylvain Guerard, Jean-Michel Guy, Pascale Trimoulet, Stéphane Picard, Bernard Dusfour, Aurelie Pouzet, Stéphanie Roseng, Marco Franchi, Pierre Jaïs, Isabelle Pellegrin & ASCCOVID Investigators
Sports Medicine - Open volume 8, Article number: 83 (2022)

Background
There is a paucity of data on cardiovascular sequelae of asymptomatic/mildly symptomatic SARS-Cov-2 infections (COVID).

Objectives
The aim of this prospective study was to characterize the cardiovascular sequelae of asymptomatic/mildly symptomatic COVID-19 among high/elite-level athletes.

Methods
950 athletes (779 professional French National Rugby League (F-NRL) players; 171 student athletes) were included. SARS-Cov-2 testing was performed at inclusion, and F-NRL athletes were intensely followed-up for incident COVID-19. Athletes underwent ECG and biomarker profiling (D-Dimer, troponin, C-reactive protein). COVID(+) athletes underwent additional exercise testing, echocardiography and cardiac magnetic resonance imaging (CMR).

Results
285/950 athletes (30.0%) had mild/asymptomatic COVID-19 [79 (8.3%) at inclusion (COVID(+)prevalent); 206 (28.3%) during follow-up (COVID(+)incident)]. 2.6% COVID(+) athletes had abnormal ECGs, while 0.4% had an abnormal echocardiogram. During stress testing (following 7-day rest), COVID(+) athletes had a functional capacity of 12.8 ± 2.7 METS with only stress-induced premature ventricular ectopy in 10 (4.3%). Prevalence of CMR scar was comparable between COVID(+) athletes and controls [COVID(+) vs. COVID(−); 1/102 (1.0%) vs 1/28 (3.6%)]. During 289 ± 56 days follow-up, one athlete had ventricular tachycardia, with no obvious link with a SARS-CoV-2 infection. The proportion with troponin I and CRP values above the upper-limit threshold was comparable between pre- and post-infection (5.9% vs 5.9%, and 5.6% vs 8.7%, respectively). The proportion with D-Dimer values above the upper-limit threshold increased when comparing pre- and post-infection (7.9% vs 17.3%, P = 0.01).

Conclusion
The absence of cardiac sequelae in pauci/asymptomatic COVID(+) athletes is reassuring and argues against the need for systematic cardiac assessment prior to resumption of training
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