Resumen slovenian table tennis and badminton players
As a result of increasing participation, intensity, demands and longer training periods, the potential risk of injuries in table tennis and badminton seems to increase in all levels of athletes. It is necessary to understand what factors have to be involved in an injury-prevention strategy for both sports activities. On the sample of 43 top Slovenian athletes we have studied the frequency of injuries among table tennis and badminton players, types of injuries and severity of injuries – the latter based on data of players absences from training and/or competition processes. Although table tennis and badminton are one of the less risky sports, there are some injuries in best Slovenian players. The most liable parts to injuries are shoulder girdle, spine, wrist and ankle, while other parts of body are less liable to injuries. According to this data, the majority of injuries occur halfway through a training session. The injuries primarily pertain to muscle tissues; these are followed by tendon injuries. Compared to badminton players, table tennis players suffer from fewer injuries.
Table tennis and badminton are not only two of the most popular sports in the world but also two of the most common sports for people in aged from 7 to 99 not only as recreational sport, but also as sport for rehabilitation. Table tennis and badminton are an ideal sport for young and old because of its extremely low risk of injury (Kondri?, Furjan-Mandi?, Mišigoj-Durakovi?, &Karpljuk, 2001). The statistical data on acute and chronic injuries in sport show that table tennis is way at the end of the list. There are hardly any injuries reported in recreational table tennis (Weber, 1982; Scott, 1992; Hochenbichler, 1992). Jørgensen and Winge (1987) reported that in badminton there are frequent overuse injuries (74%) as acute injuries (26%). A number of top athletes in Slovenia is increasing which means that we are facing a problem of sport injuries. Because these injuries occur during sport activities (training and competition), the role of physicians goes beyond a mere diagnosis and injury treatment; Physicians are required to take part in the rehab process, training advisory, they help athletes get back to practicing sport and help decrease the risk of potential injuries. Having this in mind, we must be aware of the problem complexity. Namely, not only we need to treat an injured athlete, the treatment must start as soon as possible as most athletes wish to return to training and competitions in the shortest time possible. As a result, sport physicians must very well know the strains athletes are exposed to in a particular sport. In addition they must have the knowledge of patho-physiology of sport injuries. It can be stated that a sport physician, who only treats the injured not offering help to get the athletes back to sport activities, is only doing half of his/her job (Derviševi?, & Hadži?, 2002). The potential risk of injuries in sport seems to increase for all levels of athletes with increasing participation, intensity and demands, as well as longer training periods. As with any other sport, there are some injuries that are typical of table tennis and badminton. Sport medicine findings, along with medicine and science findings, inevitably contribute to injury prevention and injury treatment programs for the players. For effective prevention, it is important to understand the functional anatomy and patho-physiology of injuries of different tissues. For injury prevention it is also necessary to understand the importance of excessive load and how these loads are distributed, sports-injury mechanisms, and the biochemical response of body tissues to impact and overuse (Kondri?, &Furjan-Mandi?, 2003). Sports medical examinations of table tennis and badminton players should not merely be an additional examination by a primary care physician. A physician must have, in addition to expertise in anatomy and physiology of the human body, also a profound knowledge of various loads, which often reach the limit or even exceed an athlete’s physiological capabilities. Generally, sport injuries can be classified as trauma and overuse injuries. Trauma injuries occur as a consequence of a specific accident or event. Such injuries are sprains and dislocations. Overuse injuries develop gradually and they can occur during a training or competition, or they gradually develop for weeks or months. A typical example of overuse injury is Achilles tendon injury. The player first feels a slight pain after a training process. Over the night, the pain is gone but reappears after each consecutive training. The damage progressively becomes worse and results in serious problems. Causes of sport injuries vary, from inadequate warming up, insufficient physical shape, inappropriate training, short rehabilitation process, anatomic factors, improper sport technique, inappropriate footwear, inappropriate protective equipment, inappropriate practicing surface, previous injuries and other. The aetiology of overuse injury is multifactorial, involving both intrinsic and extrinsic factors. Intrinsic factors are related to the athletes themselves, including anatomical, alignment, growth/age, muscle tendon imbalance, genetic endowment, general health, nutritional status and prior injury (Sparrow, 2001; in Maffullin et al, 2001). Extrinsic factors include training error, equipment inadequacy and environmental factors (Brukner, & Khan, 1997). The impact of each of these factors on the clinical presentation needs to be evaluated in order to gain an accurate diagnosis around which the treatment can be planned. A good knowledge of these factors and appropriate measures taken to solve them is a prerequisite to prevent a number of injuries, or at least to decrease the injury incidence and severity in table tennis and badminton. The incidence of injury levels needs to be reduced and it can be achieved by concentrating more on preventative measures.
Subjects and methods
Within the project Epidemiology of sport injuries in racket sports in Slovenia, 43 top Slovenian athletes (table tennis 17 and badminton 26) were questioned. At the time when the questionnaires were distributed, these athletes had an international or national ranking (as per Slovenian Olympic Committee criteria). For the purpose of this study, a questionaire of 42 questions pertaining to sport injuries among top Slovenian athletes was used. Data has been processed by the SPSS software for PC at the computer data processing department of the Institute of kinesiology, Faculty of Sports. The basic statistical parameters have been calculated (mean, standard deviation, frequency of answers). To ascertain differences between individual sports, the analysis of variance ANOVA has been used.
In this project, 50 questionnaires were mailed to top Slovenian athletes, among which 23 are table tennis players and 27 badminton players. The questionnaires were mailed to those athletes who were listed in the publication by The Slovenian Olympic Committee »Obvestila – seznam kategoriziranih športnikov v Republiki Sloveniji« [Announcements – list of categorized athletes in the Republic of Slovenia], and whose medical records were at the same time at the clinic of sports medicine CMŠ in Ljubljana. According to the instructions provided, 43 athletes returned the questionnaires. The average age of the athletes questioned was 21, 5 years.
Table 1: Basic data of monitored athletes.
Figure 1: Training and competitive status of top athlete
Table 2: Injury location
Figure 2: Injury location in both sports
Table 3: Percentage of injuries on muscles, tendons and joints per individual sport
Figure 3: Injuries of individual parts
Table 4: Sum of all injuries reported by athletes
Table 5: Number of injuries
Table 6: Comparison between table tennis players and badminton players (One-way ANOVA table)
Participation in competitive sports places the athlete in a situation in which injuries are possible at any given time. The aims of this study were to establish: – frequency of sport injuries among top Slovenian athletes, – types of injuries, – severity of injuries based on data of players absences from training and/or competition processes. These would serve as a base for further in-depth studies. Based on the results of the study, it can be presumed which prevailing risk factors are causing an injury to occur, and plan the injury prevention measures accordingly. Traditionally, table tennis has been associated with a low injury rate and the same holds for badminton. However, the number, distribution and nature of injuries within table tennis and badminton have not been well defined due to poor injury definition reporting. Overuse disorders can be considered injuries to normal tissue as a result of cumulative, repetitive sub maximal micro trauma due to inadequate time for recovery between stress episodes (Krivickas, 1997). The highest in number of injuries (23,3%), as expected, are shoulder girdle injuries. However, interesting is the constellation that the number of these injuries is far higher in table tennis as in badminton. According to extreme loads of the shoulder girdle in table tennis due to bigger ball (40 mm) it can be concluded that a higher number of injuries in table tennis is a result of short, abrupt and extremely rapid movements, particularly in forehand strokes. With the introduction of a bigger ball, these strokes have become even more abrupt. (Kondri?, Furjan-Mandi?, & Medved, 2003).
The integrated functions of the rotator cuff muscles and the scapular stabilizers, coupled with the large multiplanar movements inherent in table tennis skills, make the shoulder complex vulnerable to injury. Successful rehabilitation programs for injury to the shoulder complex must be tailored to the individual, based on accurate diagnosis of the tissue damage and pathomechanics, clinical signs, stage of growth and specific table tennis skills demands. As many table tennis players experience pain only during specific skill execution, normal physical testing of the shoulder is often not sufficient to reproduce the table tennis player’s pain. Therefore, functional testing must be used in order to identify the pain-provoking position with estimation of the force, direction and magnitude of muscle activity. There are more injuries that occur during a training period (table 5). The result is not expected as the number of risk factors increases – such as considering the opponent, violation of fairplay, increased motivation – and consequently athletes are overdoing (enthusiasm), and considering all other factors putting players at risk on the competitions. This is particularly interesting because it possibly indicates inadequate warming up, lack of stretching exercises prior to practicing and similar. Unfortunately, even at major events such as World or European championships, it is evident that some top athletes are either not familiar or are not well informed about proper warm-up and stretching. Although there are few studies focused on the medical aspects of table tennis, Shida et al (1994) reported 25.1% injuries of waist (lumbago), 15,7% of shoulder and 14.1% of knee joint. Many of reported disorders were referable to the specific nature of the practice. After treatment, more than 95% of players had no hindrance in resuming the game. Jørgensen and Winge (1987) reported 74% overuse and 26% acute injuries on Denmark badminton players. They also reported that there is 2,9 injuries pro 1000 playing hours. Azarbal et all (2004) found that 17.7% of badminton players had a history of medial elbow pain during training reflecting a history of medial elbow injury including medial epicondylitis, ulnar nerve injury, medial collateral ligament injury, medial elbow intra-articular pathology, or any combination of these causes. The most frequent injuries in table tennis and badminton pertain to muscle tissues (table 4), followed by tendon injuries. These records more or less correspond to the epidemiology of sport injuries records in the world literature. Percentage wise, the shoulder joint injuries are ranked highest, which again corresponds to the world epidemiology records. Shoulder is the most flexible body part and therefore most vulnerable. In both racquet sports, the trunk is significantly involved in all strokes players perform. Any factor that reduces the range of motion or impairs the muscle control of the trunk inhibits the efficient transference of force, leading to compensation and potential injury. Accurate figures for the incidence and nature of low back pain and injury in table tennis and badminton players are difficult to establish due to the limited prospective sport-specific research. There are various sites around the hip that are weak as a consequence of open physeal plates.
Quite large pieces can be pulled off, particularly with sudden unexpected loads. The anterior-inferior iliac spine tends to go in badminton when the front leg is suddenly blocked. Because of these abrupt blocking movements, the percentage of ankle injuries is as high as 9,3%. Spine injuries (7,0%) more or less pertain to lower back pain or overuse injuries. Overuse injury to the pars interarticularis is quite common in the young athlete (Pizzutillo, 1985). To perform an efficient initial stroke (e.g. serve in table tennis), the player must have a very flexible wrist. This is also true for some other types of strokes in table tennis and badminton, performed from the wrist; or in table tennis performed by the penholder players. The wrist is a complex functional unit. While acute injuries can, and do, occur, the greatest presentation is for non-specific wrist pain often associated with chronic stress-related reaction implicating the growth plates. Grip strength testing can be used as a useful screening and evaluating tool in managing chronic wrist pain. The complex structure and function of the foot and ankle are essential for effective footwork of table tennis and badminton players. Like the wrist, the ankle has little local muscle support, relying for its function on mechanical efficiency of its capsular and ligamentous structures; and unlike the knee, the ankle joint has no major surrounding stabilizing muscles. The lateral collateral ligaments and the medial collateral ligament, or deltoid ligament, establish the ligamentous integrity of the ankle joint, and these structures limit and stabilize the range of motion at the ankle joint. Because of fast lateral movements in table tennis and all round movements in badminton, the integrity of the foot is essential, as shoe support and orthotic devices cannot be used to modify poor foot biomechanics. A high percentage of injuries of ankle and foot joints (11,6% in badminton), indicates that badminton players should pay more attention to choosing appropriate footwear to avoid those injuries. All muscles acting to move the foot at the ankle joint arise in the leg, and so the ankle joint is susceptible to injury in the frontal plane (i.e. inversion/eversion). There are some differences among table tennis and badminton players (table 6). Training errors are the most common cause of overuse injuries. These errors involve a too rapid acceleration of the intensity, duration or frequency of player’s activity. Overuse injuries also happen in people who are returning to a sport or activity after injury and try to make up for lost time. There are also technical, biomechanical and individual factors. Proper technique is critical in avoiding overuse injuries. Due to a large number of injuries in training session players should be adequately prepared with warm-ups and training sessions before practices as well as before games. This will help ensure that that player has fun and reduce the chances of an injury. Differences among table tennis and badminton players in hours of practice session, physical preparation and stretching show us that there has to be done more that it was till now. The results show us that table tennis players have fewer injuries as badminton players. Some players are more prone to overuse injuries and this is usually related to anatomic or biomechanical factors. Imbalances between strength and flexibility around certain joints predispose to injury.
The poor recognition, localization and reporting of pain by table tennis and badminton players can often delay access to appropriate and timely intervention to prevent injury chronicity. The first requirement for effective management of table tennis and badminton injuries is therefore prevention, based on an understanding of the factors involved in overuse injuries generally, and table tennis injuries specifically. The high repetition of activity necessary to develop and perfect table tennis and badminton skills produces the potential for chronic overuse injury. Poor technique, coupled with the anomalies of growth and improper equipment, produce skill errors, which may result in an increased stress on the muscoloskeletal tissues and produces pain in response to micro trauma or overload. To minimize the pain response, the body adopts compensatory mechanisms, which ultimately add to the skill errors, and the never-ending circle of overload is established. One major responsibility of the racket sports trainer is to make the training and competitive environment as safe as possible to reduce the risk of injury. If an injury could have been prevented initially, then there would have been no need for first aid and subsequent rehabilitation. The trainer, in cooperation with the team physician and doctor, should obtain a medical history and conduct physical examinations of the athletes before participation as a means of screening for existing or potential problems. If the trainer knows at the beginning of the season that an athlete has a physical problem that may predispose that athlete to an injury during the course of that season, then corrective measures that may significantly reduce the possibility of additional injury may be implemented immediately. In addition, the database records obtained in such studies contribute to health care planning and organization for top Slovenian athletes, who inevitably require a better and qualitative medical supervision primary care physicians could offer. From that point of view it is therefore very important that a trainer works closely with and under supervision of the team physician and team doctor.
- 1. Azarbal, M., Adybeik, D., Ettehad, H. & Arash Kia, M. (2004). A Survey Of Elbow Injuries In Badminton Players: The Internet Journal of Orthopedic Surgery. 2004; Volume 2, Number 1.
- 2. Brukner, P., & Khan, K. (1997). Clinical sports medicine. Sydney:McGraw-Hill.
- 3. Derviševi?, E. Hadži?, V. (2002). Knee and shoulder injuries in comparison with other sport injuries in high profile sportsmen in Slovenia a prospective study. In: Di Pietro, Edoardo (Ed.). Abstracts book. Citta di Castello: A.C. Grafische.
- 4. Hochenbichler, A. (1992). Sportverletzungen und überlastungsyndrome im Leistungssport Tischtennis. München.
- 5. Jørgensen, U., & Winge, S. (1987). Epidemiology of badminton injuries. International Journal of Sports Medicine. 8(6):379-82.
- 6. Kondri?, M., Furjan-Mandi?, G., Mišigoj-Durakovi?, M., & Karpljuk, D. (2001). Table tennis as a leisure and rehabilitation sporting activity. In: Bartoluci, Mato (Ed.), Heimer, Stjepan (Ed.), Ruži?, Lana (Ed.). Sport for all-health-turism : [proceedings of the 2nd CESS Conference]. Zagreb: CESS – European Confederation Sport and Health: Faculty of Physical Education University of Zagreb: Croatian Association “:Sport for All”, pp. 216-219.
- 7. Kondri?, M., Furjan-Mandi?, G., & Medved, V. (2003). Myoelectric and neuromuscular measures of forehand strike in table tennis executed with balls of two different sizes. In: 8th International Table Tennis Federation Sports Science Congress and 3rd World Congress of Science and Racket Sports, 17 th -19 th March 2003, INSEP, Paris, Francija – Programme and abstracts. Programme and abstracts : les entretiens de l’INSEP.
- 8. Kondri?, M., & Furjan-Mandi?, G. (2003). Zakonitosti kondicijskih programov v treningu namiznoteniškega igralca. [Rules for designing physical preparation in table tennis]. Top spin (Ljubl.), 2(5):3-6.
- 9. Krivickas, L.S. (1997). Anatomical factors associated with overuse sports injuries. Sports Medicine. 24(2):132-146.
- 10. Maffulli, N., Chang, K.M., MacDonald, R., Malina, R.M., & Parker, A.W., (2001). Sports Medicine for specific ages and abilities. London: Harcourt Publishers Limited.
- 11. Pizzutillo, P.D. (1985). Spondylolisthesis: etiology and natural histroy. In: Bradford D.S., Hensinger R.M. (eds). The pediatric spine. Thieme, New York, pp. 395-402.
- 12. Scott, M.J. (1992). ITTF questionare of elite athletes at 41st World table tennis championships. International Journal of Table Tennis Sciences, No. 1, pp. 191-193.
- 13. Shida, Y., Shida, S., Suzuki, S., Murakami, H., & Youza, N. (1994). Injuries and systematic disorders of table tennis players. International Journal of Table Tennis Sciences, No. 2 pp. 121-122.
- 14. Weber, K. (1982). Analyse der körperlichen Beanspruchung in den verschiedenen Rückschlagspielen unter dem Aspekt der Präventiv- und Leistungsmedizin. In: Andersen/Hagedorn: Training im Sportspiel. 4. Int. Sportspielsymposium. Ahrensburg. Pp. 111-133.