Includes bibliographical references (leaves 121-128). / Background: Previous clinical research of football players participating in international tournaments has mainly focussed on documentation of injuries and risk factors for injury. However, despite anecdotal evidence that medical symptomatology, illness and medical complaints are common during travel to international competitions, the epidemiology of medical conditions before, during or after elite level football tournaments, has not been well documented. Objective: The aims of the research presented in this dissertation were: 1) to determine the prevalence of medical conditions in elite football players 2) to determine the incidence and nature of medical conditions and illness in the elite football players participating in an international tournament (2009 FIFA Confederations Cup tournament) and 3) to provide data for the medical planning and management of elite football players during future events. Methods: The first component of this dissertation consisted of a comprehensive review of the current literature describing the prevalence and incidence of medical conditions and illness in athletes. The original research component of this dissertation consisted of two parts, and both studies were conducted during the FIFA Confederations Cup tournament, which was held in South Africa in June 2009. All the players in the 8 participating teams (23 players per team – a total of 184 players) were approached by the FIFA Medical Assessment and Research Centre (F-MARC) through their team physicians and invited to participate as research subjects in the studies. Part 1 (descriptive cross-sectional study): Prior to the tournament, all the players completed a previously validated medical history and illness questionnaire. Furthermore, the questionnaire contained sections on player demographics, training history, medication and supplement use, life-style history, family history of atopy, current and past history of medical conditions and detailed sections pertaining to upper respiratory tract infections (URTI), allergies, asthma, exercise associated muscle cramping (EAMC) and history of previous surgery. Part 2 (prospective cohort study): During the 15 days of the tournament each team physician was requested to complete a daily injury, medical illness and treatment log for each player. Finally, data on the environmental conditions at each venue were collected, as recorded by the South African Weather Service. Results: The main findings in part 1 of this study were: 1) exercise associated muscle cramping (EAMC) was the most prevalent medical condition reported, with 64 (46%) of the players reporting a history of EAMC, 2) the prevalence of allergy was 27 (20%) and asthma 6 (4%), 3) the prevalence of dermatological conditions was 16 (12%), 4) the prevalence of gastro-intestinal conditions was 10 (7%) and central nervous system conditions was 6 (4%), 5) URTI one week before the tournament was reported by 7 (5%) of the players, 6) 68 (49%) of the players reported a history of previous surgery and 7) 72 (52%) of the players reported the use of supplements or vitamins and 11 (8%) the use of medication. Knee surgery was the most common anatomical area operated with 33 (24%) of the players reporting previous knee surgery. This was followed by a much lower prevalence of ankle surgery, 8 (6%). In part 2 of the study, a total of 56 injuries and 35 illnesses were recorded during the tournament. The main findings in this study were: 1) an overall injury rate of 64.4 injuries per 1000 match hours or 2.1 injuries per match, 2) an overall rate of 2.7 injuries and 1.7 illnesses per 100 player days, 3) that 0.88 days were lost per injury and 0.46 days were lost per illness, 4) the lower limb was the most commonly injured body part, 5) 11 (20%) of the injuries reported were to the thigh, 6) 15 (44%) of the injuries reported were due to a contusion, 6) 13 (37%) of the illnesses reported were due to ENT conditions, and 7) 7 (20%) were due to respiratory tract symptoms. Summary and conclusion: Illness and injury are common during an international football tournament. The pattern of injury was similar to that previously reported. However, the novel finding of this dissertation was that illness is a significant component to the medical care to a travelling team and needs to be considered by team physicians managing the medical needs of elite football teams.

Includes bibliographical references / Background: Illness in athletes is an inevitable part of participation in sports, and can significantly interfere with training, during tournaments or at competition time. The incidence of illness in sports varies in different sporting codes and across different tournaments and competitions. The Super Rugby competition is a particularly demanding 16-week tournament among countries in the Southern Hemisphere, and is associated with a high incidence of illness. In this tournament, 15 rugby union teams compete and play international level matches every week, which involves travel across numerous time zones and therefore may be associated with a higher incidence of illness in players. Objective: The main objectives of this dissertation were to 1) review the epidemiology and risk factors for illness in athletes participating in tournaments or competitions, and 2) determine which intrinsic risk factors predispose players to illness during the 2010 Super Rugby tournament. Methods: This dissertation consisted of two main phases. In phase I, a systematic review of the literature was undertaken, using evidence-based criteria, to determine which risk factors predispose athletes to illness during tournaments. In phase II, a prospective cohort research study was undertaken, involving 239 players from South Africa and New Zealand, over the 16-week duration of the 2010 Super 14 Rugby Union tournament. For phase II, a pre-season medical questionnaire was administered to determine baseline medical data. Collection of data then took place each day of the competition, beginning 7 days before the first game the team played, and ending when each team played their final game. Each team physician completed a daily "medical illness log" for every player. Booklets were supplied that contained daily illness report forms. Results: The main findings of the review (phase I) were good evidence (level I and II) indicating that 1) international travel, and the duration of a tournament are extrinsic risk factors for illness in athletes, and 2) that prolonged and high intensity training, older age, and nutritional deficiencies are intrinsic risk factors for illness in athletes. The main findings of the prospective cohort study (phase II) were that an increased number of training days in the 2 weeks before the tournament was an independent risk factor for any illness, respiratory system illness, and digestive system illness; the % time spent on endurance training in the 15 weeks before the tournament was an additional independent risk factor associated with respiratory system illness; the use of anti-inflammatory medication was an independent risk factor associated with respiratory system illness. Summary and conclusion: In summary, novel intrinsic risk factors for illness in rugby players participating in the Super Rugby tournament were training more days/hours per week in the 2 weeks before the tournament, as well as endurance-type training 15 weeks before the tournament. These data can form the basis of planning preventative strategies to reduce the risk of illness in the Super Rugby tournament.

Includes bibliographical references. / The International Paralympic Committee (IPC) has witnessed growing participation in the Games since its inception and has made strong efforts to collect comprehensive injury and illness data during the London 2012 Paralympics. Until now, no studies have comprehensively evaluated upper limb injuries at the Paralympic Games. To describe the epidemiology and clinical characteristics of upper limb injuries in athletes participating in the London 2012 Paralympic Games and identify the groups of athletes at risk. This study forms a component of the large prospective cohort study conducted over the 14-day period of the London 2012 Paralympic Games, coordinated through the IPC Medical Committee. Data were collected in two phases. Phase 1 involved the determination of the incidence and severity for 3,565 athletes (85% of the Paralympic athletes) from a collation of three data sources, providing 46,606 athlete days of data for analysis. Phase 2 involved the collection of more detailed medical data using a novel web-based surveillance system for 3,329 athletes participating in the study (80% of Paralympic athletes). Incidence proportion (IP) has been defined as the number of injuries per 100 athletes (%) during the study period. Incidence rate (IR) has been defined as the number of injuries per 1000 athlete days for the study period and 95% confidence intervals (CI) are reported in parentheses.

Epidemiological data is important to better understand injury and illness patterns in para athletes. Medical teams used a web-based injury and illness surveillance system (WEB-IISS system) to all the para-athlete injuries and illnesses during the 2012 London Paralympic games. All team physicians could access the system at any time to log data, providing a vast database for potential research. The relative ease of data collection permits large amounts of data to be analysed, providing important surveillance data on injury and illness. Data on the South African para-athletes, provided by the team's Chief Medical Officer, were assessed and compared to all countries. This study aimed to describe the illness and injury profiles in South African elite paraathletes who participated in the 2012 Summer Paralympic Games; and compare these profiles to data from the other countries that participated. A retrospective sub-analysis of the data-set collected from a large prospective study of injury and illness at the London Summer Paralympic Games in 2012 was compared to data collected on all para-athletes from input by team physicians into the WEB-ISS system. In total, 62 South African para-athletes presented with 19 injuries, with an injury rate of 21.9 per 1000 athlete days. Twenty-five para-athletes presented illness, with an illness rate of 28.8 per 1000 athlete days. The overall injury and illness rate in the South African para-athletes was higher than the injury and illness rate in all para-athlete participants at the London Paralympic Games. The anatomical distribution of injuries (lower limbs, axial and upper limbs) and the nature of illness (respiratory, skin & subcutaneous and digestive systems) were however similar. Causative factors are not evident and need to be further studied. Increased efforts in injury and illness surveillance and preventative programmes should be employed to reduce the incidence of injury and illness, and their severity . Such efforts in para-athlete care should be ongoing with surveillance to monitor and manage trends to ensure the culmination of Paralympic competition does not result in high rates of injury and illness. Education of healthcare providers, para-athletes, coaches and others in the management of para-athletes, is key.

This thesis explores the general public s experiences of sport related injury (SRI) as they utilise Sport and Exercise Medicine services in NHS England. It focuses specifically on: the treatment pathways to, and utilisation of, one Sport and Exercise Medicine (SEM) clinic in NHS England; the social and economic costs incurred as a consequence of SRI; and the extent healthcare utilisation and costs coalesce to structure SRI experience. The study employs a qualitative methodology based on a two phase research design that retrospectively maps the pathways of patients (n=19) up until their treatment at the SEM clinic (focusing on social and economic costs ), and prospectively, as a number of patients (n=4) continue their treatment at the SEM clinic, thus illustrating how pathways and costs feed each other in problematic ways. Findings demonstrate that patient pathways to SEM are relatively lengthy and inefficient due to a lack of knowledge of SEM initiatives for SRI treatment amongst both GPs and patients. This leads to indirect referrals, increased workload in primary care and the utilisation of general orthopaedic secondary care services. It further highlights a number of social and economic costs incurred through SRI, such as diminished social wellbeing, increased emotional labour, poor health behaviours and workplace absenteeism, which are exacerbated through inefficient patient pathways and patient dissatisfaction with general orthopaedic treatment. The thesis is the first study to shed light on the pathways of SRI patients in the NHS and the treatment experience of SEM clinics in NHS England. It demonstrates the extent SEM initiatives justified on the basis of improving the efficiency of pathways and satisfaction of treatment for SRI patients could be more effectively implemented and identifies a number of important implications for the future sustainability of physical activity health promotion policy and the wider social and economic productivity of exercising public populations.