Subsequent Injury in Sport: Classification and Prevention of Injury in Athletic Populations

Submission note: A thesis submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy to the La Trobe Sports and Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Victoria, Australia.

Thesis with publications.

Injuries can substantially burden individual athletes and sporting organisations. The association between previous injury and subsequent injury is poorly understood, thus limiting the capacity for prevention. The overall aim of this thesis was to investigate the relationships that exist between subsequent injury and previous injury; and to examine the epidemiological determinants associated with subsequent injury occurrence, to guide injury prevention strategies in sport. The aim was achieved through the completion of a series of linked studies. A systematic review of the literature identified a variety of lower limb injuries sustained by athletes were associated with a previous history of an injury of a different type. The second study presented an updated subsequent injury categorisation (SIC-2.0) model that allowed classification of the relationships between a subsequent injury and previously sustained injuries. The creation of a statistical script allowed the categorisation process to be automated with 100 percent reliability to manual coding demonstrated. The third study found comparable categorisation outcomes between the new SIC-2.0 model and the original SIC-1.0 model, whilst demonstrating the additional benefits offered by the data-driven approach of the new SIC-2.0 model. Subsequent injury characteristics and inter-injury relationships were then investigated in two cohort studies in elite sprint kayak and elite rugby sevens. Subsequent injuries were found to be common in both studies, the majority of which were different to previous injuries. Examination of the relationship between workload exposure and subsequent injury demonstrated that injury characteristics change as the number of injuries increased, and that time between injuries reduced as the number of successive subsequent injuries increased. This research provides an evidenced-based framework to classify the inter-injury relationships that link an athlete’s injuries during a time series. This research provides a foundation for the investigation of causal factors that can be then used to direct future injury prevention strategies.