title: Multiple factors explain injury risk in adolescent elite athletes: Applying a biopsychosocial perspective.
abstract: Many risk factors for injury are presented in the literature, few of those are however consistent and the majority is associated with adult and not adolescent elite athletes. The aim was to identify risk factors for injury in adolescent elite athletes, by applying a biopsychosocial approach. A total of 496 adolescent elite athletes (age range 15-19), participating in 16 different sports, were monitored repeatedly over 52 weeks using a valid questionnaire about injuries, training exposure, sleep, stress, nutrition, and competence-based self-esteem. Univariate and multiple Cox regression analyses were used to calculate hazard ratios (HR) for risk factors for first reported injury. The main finding was that an increase in training load, training intensity, and at the same time decreasing the sleep volume resulted in a higher risk for injury compared to no change in these variables (HR 2.25, 95% CI, 1.46-3.45, P<.01), which was the strongest risk factor identified. In addition, an increase by one score of competence-based self-esteem increased the hazard for injury with 1.02 (HR 95% CI, 1.00-1.04, P=.01). Based on the multiple Cox regression analysis, an athlete having the identified risk factors (Risk Index, competence-based self-esteem), with an average competence-based self-esteem score, had more than a threefold increased risk for injury (HR 3.35), compared to an athlete with a low competence-based self-esteem and no change in sleep or training volume. Our findings confirm injury occurrence as a result of multiple risk factors interacting in complex ways.
authors.affiliation: Division of Physiotherapy, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Huddinge, Sweden.
authors.forename: P
authors.identifier: http://orcid.org/0000-0002-8368-0341
authors.initials: P
authors.lastname: von Rosen
authors.affiliation: Division of Physiotherapy, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Huddinge, Sweden.|Swedish Sports Confederation Centre, Bosön SportsClinic, Lidingö, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Frohm
authors.affiliation: Division of Physiotherapy, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Huddinge, Sweden.|Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: A
authors.initials: A
authors.lastname: Kottorp
authors.affiliation: Division of Physiotherapy, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Huddinge, Sweden.|St Erik Academic Primary Healthcare Centre, Stockholm, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Fridén
authors.affiliation: Division of Physiotherapy, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Huddinge, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Heijne
mesh_terms: D000293:Adolescent; D056352:Athletes; D001265:Athletic Injuries / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D064797:Physical Conditioning, Human; D012044:Regression Analysis; D012307:Risk Factors; D012649:Self Concept; D012890:Sleep; D013177:Sports / Q000523:psychology*; D011795:Surveys and Questionnaires; D013548:Sweden; D055815:Young Adult
keywords: athletic injury; diet; self-esteem; stress; youth