Abstract
Introduction
Olympic class sailing injuries are a minimally researched topic. Our study includes 15 y of data from medical coverage of the Miami venue during the Sailing World Cup. The objective was to examine the nature of Olympic class sailing injuries and illnesses during competition.
Methods
The records of the medical clinic encounters of a World Cup Sailing regatta were reviewed. Summary statistics and nominal categorized data regarding demographics, onset, mechanism, nature of condition, and referral were collected.
Results
There were 740 clinic encounters, ranging from 20 to 70 annually. Five hundred fifty-five (75%) were musculoskeletal in nature, and 184 (25%) were related to medical concerns. Twelve athletes were referred to the emergency department (ED), averaging <1 per year. However, 6 (50%) of the ED referrals came from NACRA 17, 49er, and 49er F-X classes, representing a 16% ED referral rate by fleet per year. In contrast, the remainder of the classes had a 0.04% ED referral rate. The lumbar spine, cervical spine, and foot/ankle were the most common body regions treated. Laser Radial sailors had 71(10%) visits, the most per class. Coaches and staff represented 59 (8%) visits.
Conclusions
Olympic class sailing venue medical coverage should be equipped to treat a variety of acute and chronic injuries and illnesses among athletes as well as coaches and staff. Overall, rates of ED or other off-site referrals are low but higher for 49er, 49er F-X, and North American Catamaran Racing Association (NACRA)-17 classes.
Introduction
Olympic class sailing injuries are a minimally researched area of sports medicine. Evidence regarding sailing injury rates and characteristics is largely based upon survey data rather than clinical evaluation by a medical professional. Only 8 studies 1 -8 in the English language have reported on injuries among Olympic class sailors. Prospective studies have mostly involved a single team of athletes,2,3 with the primary focus on injuries suffered during training.1,6 Three studies4,5,7 report injuries and illness occurring during the Olympic games. These studies were not designed to examine sailors exclusively and relied on supplemental reporting by National Olympic Committee medical teams. Additionally, the athletes competing at the games represent a small number of elite and well-trained sailors. One study 8 to date has observed injury and illness at a specific sailing event and includes data solely from a single year.
Additionally, many authors have evaluated the physiology 9 -11 and physical demands12,13 of sailing. This has been translated into theories on injury prevention in the lay press primarily. However, a better understanding of injury characteristics and incidence will allow for formal study of possible injury prevention techniques.
Olympic class sailing encompasses multiple classes of one-design sailboats. The boat classes have varied over years of the event. Newer technology has allowed for boats to be designed to be faster, but these newer boat classes (49er, 49er FX, and North American Catamaran Racing Association [NACRA] 17) are also observably less stable and, therefore, more prone to capsize while traveling at high speed. In one study, 8 these classes had the most injuries, with the majority being acute in nature as opposed to overuse injuries. Table 1 describes Olympic class sailboats.
Description of Olympic class sailboats
The objective of this study was to better characterize the variety of medical conditions and injuries sustained by Olympic class sailors. This offers a better understanding of the medical care these athletes require and provides medical professionals with an accurate understanding of the injuries and illness they may encounter in coverage of Olympic class sailing events.
Methods
This study was approved as a nonhuman subjects’ review by the institutional review board at the University of Miami (IRB ID 20200358). The demographics, onset, mechanism of injury (MOI), nature, ultimate referral, and circumstances of each athlete encounter were collected through a retrospective review of deidentified regatta venue medical clinic records.
Procedures
Medical information was collected on site as the encounters occurred. All encounters, including athletes, staff, and volunteers presenting to the medical clinic during the Rolex Miami Olympic Class Regatta event from 2006 to 2009 and the World Sailing World Cup Series Miami event from 2010 to 2020, were included. Records were deidentified prior to data collection. Up to 650 athletes from 60 countries competed over the 6-d events each year. The medical clinic was staffed by physicians and physical therapists. It was open to all athletes, coaches, and regatta staff for the duration of the event. Injuries and illness data were collected by the medical providers.
Statistics
Summary statistics and nominal categorized data were merged into an Excel spreadsheet. Analysis was performed by SAS 9.4 (SAS Inc, Cary, NC). There were 14 missing data points (1 sex, 2 class, 2 position, 3 level, 3 region, 1 subregion, and 2 nature). Two encounters were missing more than 1 data point, with 2 points missing each. The total number of subjects analyzed in these categories was modified accordingly.
Results
Overall, up to 740 encounters were analyzed. Athletes comprised 620 (84%) of the clinic encounters, and 120 (16%) visits were by nonathletes, including coaches and regatta staff. Three hundred twenty-three (44%) were female, with the remaining 416 (56%) being males. The skipper position made up the majority of athlete encounters at 427 (69%), and 191 (31%) were crew sailors. Four hundred fifty-three (73%) were members of their national team, 60 (10%) were in a national team development program, and 104 (17%) were novice-level or yacht club sailors. Most conditions treated, 307 (42%), occurred while racing in competition, followed by on-water training, which accounted for 160 (22%) injuries.
Individuals seeking care presented with a range of 1 to 4 discrete conditions treated in the course of a single regatta. A majority of athletes and staff, 540 (73%), sought treatment within ≤7 d from the onset of their symptoms or injury, with 355 (54%) presenting to the clinic for care within 1 d of onset.
A mean of 46 (range, 27–70) total clinic encounters per year occurred over 16 y. A mean of 35 visits per year were due to musculoskeletal (MSK) complaints. A mean of 14 visits per year were related to illness or other medical concerns (IM).
Forty-five percent of visits occurred within the first 2 d of racing and 60% within the first 3 d. Overall, new clinical encounters peaked on the first day of racing with 137 (19%) visits.
Nature of Encounters
Acute injuries or illnesses accounted for the majority of clinic visits, 570 (77%) visits, followed by 124 (17%) visits for chronic overuse injuries, 39 (5%) visits for concerns with insidious onset, and 5 (1%) that could not be classified. Among the acute conditions, 120 were due to traumatic injuries, 152 were due to nontraumatic injuries or illness, and 298 were due to acute workload. This was defined as acute onset or worsening of overuse injuries due to an increase in physical workload from a higher intensity and frequency of sailing during a competition. Similar ratios were seen among only sailors (excluding coaches and staff) and regardless of sex. Sailors at the crew position had a higher percentage of acute traumatic injuries than those at the skipper position. Table 2 summarizes the nature of injury in sailors by sex, boat position, and competitive level.
Nature of injury in sailors by sex, boat position, and competitive level
n/a, not applicable.
Description of each category: acute workload represents acute onset or exacerbation of a chronic condition, acute nontrauma represents acute onset with a nontraumatic cause; insidious represents nonspecific onset or an unspecified cause; overuse represents chronic onset; and acute trauma represents acute onset with a traumatic cause.
Percent of total visits.
The sailing classes experiencing the most acute traumatic injuries over the 16 regattas were 49er with 15 and 49er F-X with 12. Interestingly, the regatta staff represented 11 of the acute trauma clinic encounters.
Twelve athletes were referred to the emergency department (ED), averaging less than 1 per year. Four were referred for possible fractures and 2 for acute knee injuries concerning for a ligamentous or meniscal tear. Other diagnoses referred to the ED included dehydration secondary to food poisoning, dislocation in the hand, shoulder dislocation, ankle sprain, concussion, and laceration. Half of the ED referrals came from 3 of the 17 classes (NACRA 17, 49er, and 49er F-X). The ED referral rate for these lighter, faster classes was 16% per fleet per year. In contrast, the remainder of the classes had a 0.04% ED referral rate by fleet per year.
Forty-two percent of visits were from injuries or other conditions that occurred while the athlete was competing. On-water training during the regatta accounted for 22% of complaints, with off-water training accounting for an additional 8%. Injuries occurring while doing maintenance work on boats, sails, and other equipment accounted for 3% of the visits. Of the athletes presenting to the medical clinic, 678 (92%) were treated on site. Five hundred forty-three (73%) were treated by the on-site physical therapist or athletic trainer, whereas 135 (18%) were treated by a physician on site. Off-site referrals included referrals to the ED, specialist physicians, chiropractors, and physical therapists in office.
Body Regions and MOI
Five hundred fifty-five (75%) visits were due to MSK concerns, and a total of 184 (25%) visits were related to IM concerns. Among the IM visits, integumentary conditions were the most common, accounting for 78 encounters. This included diagnoses such as lacerations, cellulitis, blisters and abrasions, and rashes. Fifty-six visits were for evaluation of systemic illness, including upper respiratory and gastrointestinal infections. Other common IM visits included treatment for insect bites or stings and neurologic concerns, such as headaches, concussions, and vertigo.
The lumbar spine was the body region most commonly evaluated and treated with 118 (16%) encounters, of which 75 were acute in nature. The cervical spine was the next most common with 78 (11%) encounters, followed by the foot and ankle with 76 (10%) encounters. The majority of lumbar and cervical spine complaints were related to MSK causes. The foot and ankle encounters were more varied with many IMs, including integumentary concerns along with MSK injuries, such as sprains, contusions, and tendinopathy. Table 3 summarizes the most common diagnoses by body region.
Diagnosis by body region
Data are presented as n (%).
The highest ranking is 1.
Shoulder, arm, forearm, wrist, and hand.
A wide variety of MOIs were reported. Among those directly related to sailing, line and sheet work was the most commonly reported MOI with 90 (12%) encounters. The shoulder, arm, and wrist/hand were the most common body regions affected by this MOI. Hiking was reported as the MOI for 89 (12%) encounters, resulting in pain or injury to the lumbar spine or knees most commonly. This is a sailing technique in which a sailor transfers their weight to the upwind side of the boat to gain speed, often using straps and trapeze equipment to maintain their weight over the edge of the boat. Hitting, striking, or being struck by an object accounted for 54 (8%) encounters. In 10 of those injuries, the boom was responsible. Soreness or pain from the acute workload of sailing competitively represented 33 (5%) injuries overall, with the cervical spine being the most affected region. Capsizing of the boat resulted in 22 injuries. Nineteen (3%) encounters reported trapezing as the MOI, mostly affecting the neck, knees, and thoracic spine. Seventeen (2%) falls were reported, with 4 falling from the boat and 3 falling while on the boat.
Class Distributions
The highest number of clinic contacts was among the women’s Laser Radial class with 71 (10%), followed by the women’s 470 with 70 (10%) and then 64 (9%) from the men’s Laser. Table 4 summarizes the nature of conditions treated by boat class.
Nature of conditions treated by boat class
Data are presented as n (%).
N (N/736 x 100), including both musculoskeletal and medical encounters.
Interestingly, the fourth and fifth highest contacts came from coaches with 61 (8%) encounters, followed by regatta staff with 59 (8%) encounters.
Discussion
Despite being contested since the original modern Olympic games, little is known about the incidence and epidemiology of injuries and illnesses that occur in Olympic class sailing regattas. On review of the literature, to our knowledge, this is the first study to examine injuries and illnesses that occur at a single regatta over the span of multiple years. Most of the injuries seen were acute in nature. Sixty-six percent of sailing injuries reported at the 2008 Olympic Games 4 were sustained in competition. Similarly, 63% of sailing injuries at the 2012 Olympic Games 5 occurred in competition. Here, we also found that injuries and other conditions sustained in competition accounted for the highest percentage of clinic visits.
Three-fourths of the encounters in this study were related to MSK concerns. Previous studies of sailors in Brazil 2 and New Zealand 3 identified the lumbar spine as the most common area of the body injured. Athletes participating in a Sailing World Championship regatta were surveyed regarding injuries in the past year as well as those occurring during the competition. They reported 8 the low back to be the most commonly affected region of the body in injuries over the 12 months prior to the competition, but the hand/fingers were the most common area injured in competition, followed by the low back. Here, we also found the low back to be the most common region of pain, but athletes and staff presented with injuries to all parts of the body.
A study 1 also reported athletes sustained overuse injuries more commonly than traumatic injuries over 12 months of training, accounting for 79% of injuries reported. Although acute injuries were more commonly seen in this study, 124 overuse injuries were also treated.
In planning medical coverage at an Olympic class sailing regatta, preparations should be made to address both exacerbation of chronic and overuse injuries as well as acute trauma. Plans should be in place for on-site coverage and methods of referral for acute traumatic injuries that require urgent or emergent evaluation and higher levels of care. This is especially important because technology has allowed boats to become faster, resulting in an increased number of traumatic injuries among these faster classes of boats. Higher speeds can potentially also increase the traumatic force, resulting in increased severity of the injuries when they occur. A previous study 8 reported increased injury rates with acute trauma, including fractures, dislocation, and head injuries, with the introduction of these faster classes, including 49er, 49er-FX, and NACRA 17. Similarly, we found a much higher ED referral rate for athletes in those boat classes. The sailing classes experiencing the most acute traumatic injuries over the 16 regattas were 49er and 49er F-X. The 49er F-X rate is concerning because this class has only competed in half of the regattas since it was not introduced to the Olympic classes until 2013. Approximately one-quarter of the visits here were due to IMs. Athletes and staff presented with a number of skin concerns for which water exposure needed to be considered in diagnosis and treatment. Athletes also experienced upper respiratory infections, allergic reactions, urinary symptoms, headaches, and concussion. Previous studies examining sailing competitions have also shown that illness affects a significant number of participants. Ten percent of athletes participating in the 2012 Olympic sailing competition reported 5 experiencing an illness. Similarly, in the 2016 Olympic sailing regatta, 7 12% of the athletes experienced some form of illness.
Overall, the majority of injuries and illnesses can be treated on site at the regatta. To be prepared to treat both MSK and IM concerns, a medical clinic at such an event would ideally be staffed by a physician trained in primary care as well as physicians or physical therapists trained in evaluation and treatment of MSK injuries. Although still uncommon, traumatic on-water injuries occur more frequently with the introduction of faster boats. Physicians or emergency medical personnel trained as first responders should also be available on the water on a medical boat to be mobilized quickly to the location of any injury. Radio or other forms of communication that can be relied upon offshore should be used to ensure that race officials and staff can quickly communicate with the medical staff in the event of an injury. An emergency action plan should be in place and include how to contact an ambulance for transportation to the ED, the exact address to direct the ambulance to meet the injured athlete, and an understanding of the closest ED equipped to handle trauma. It is also helpful to have in place a plan for expedited referrals to a medical specialist and other practitioners off-site. On site, equipment should be available to stabilize any athlete with a traumatic injury. This includes a cervical collar and spine board. First responders should also understand how sailors may be attached to the boat and have tools to cut ropes and other equipment as needed to free an injured athlete.
Water exposure is a concern in both evaluation and treatment of athletes. Medical staff should understand the pathogens that may be present in the water where the competition will be held as they evaluate skin and GI infections and the marine life, such as jellyfish. Additionally, in treating MSK and integumentary conditions, any tape, padding, or bandage applied needs to be waterproof.
Limitations
The event took place in the same location at the same time of the year, so caution should be taken in generalizing results to other events with variable venues and weather conditions. However, including data from many years of the event accounts for some variation in athletes and race conditions, which may allow the results to be valuable to other Olympic class sailing events and venues. Additionally, this allowed for more consistency in the data collection and improved comparisons between groups of athletes. The study also included only those athletes who presented to the medical clinic, limiting our ability to account for all injuries because some athletes may have received care from a trainer or therapist traveling with their team or may have waited to seek care once they returned home. However, as official medical providers for the event and coordinating any emergency responses and referrals for higher level of care, the authors believe that our data captured all serious injuries. Finally, 14 data points were missing from 12 encounters, which may have affected the reliability of our results.
Conclusions
Olympic sailing events present a wide range of injuries and illness that the medical staff needs to be prepared to properly evaluate and treat. The introduction of faster boats, such as the NACRA 17, 49er, and 49er FX, has increased traumatic injuries.
Abstract presented at the American College of Sports Medicine annual meeting, June 4, 2022, San Diego, CA.
Footnotes
Acknowledgments
The authors thank all of the athletes who provided full information for our records along with the many students, residents, and fellows who volunteered their time to provide medical coverage for the Miami World Cup regatta.
Author Contributions: study concept and design (CML, SEH); data acquisition (CML, SEH); data analysis (CML, SEH); drafting and critical revision of the manuscript (CML, SEH); approval of final manuscript (CML, SEH).
Financial/Material Support: None.
Disclosures: None.