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Lifetime abuse experience link to injury risk in top athletes

AbuseActive top-flight athletes who have experienced sexual or physical abuse at some time in their life run a greater risk of sports-related injury. A study from the Athletics Research Centre at Linköping University in Sweden has shown an association between lifetime abuse experience and injury risk in female athletes.

The study has been carried out on elite athletes in Sweden, and is the first of its kind to investigate the consequences of sexual and physical abuse for athletes. Earlier in 2018, the Athletics Research Centre published a report commissioned by the Swedish Athletics Association that surveyed sexual abuse within Swedish athletics.

"We wanted not only to repeat our study into the presence of abuse, but also examine what it means for the athlete. How does a traumatic event influence athletic performance? We wanted to investigate whether abuse is connected to the high degree of overuse injuries that we see in competitive athletics," says Toomas Timpka, professor in the department of medical and health sciences and head of the study.

The study focussed on the risk of injury. Does abuse increase the risk of injury related to sporting activities, or the risk of non-sports injuries? Of the 197 participants in the study, 11 % had experienced sexual abuse at some time in their life, and 18 % had experienced physical abuse. In female athletes, physical abuse brings a 12 times higher risk of sports injury. Sexual abuse involves an eight times higher high risk for non-sports injury. The correlation between abuse and an increase in the risk of injury appears most clearly in female athletes.

"Many aspects of the correlation are also seen in self-injurious behaviour. We can see in both young women and young men that they tend to blame themselves. The athletes carry the trauma inside themselves, and take risks that can eventually lead to overuse injury. At the same time, it's important to remember that not all female athletes who suffer from long-term injuries have been subject to abuse. These injuries arise in interaction between many factors, which differ from one individual to another," says Timpka.

Epidemiological studies in sport and other sport-focussed medicine have traditionally been targeted on the musculoskeletal system, while sports psychology has focussed on performance. Timpka is looking for innovative thinking in the field. He points out that several factors may explain differences in performance, and it is important to deal with emotional scars that may have been left by, for example, abuse.

"We hope that our study can pave the way for a new multidisciplinary research area within sports medicine. We can gain new insights with the aid of clinical psychologists and child psychiatrists who participate in sports medicine research."

Objective: To examine associations between lifetime sexual and physical abuse, and the likelihood of injury within and outside sport in athletes involved in competitive athletics.
Methods: A cross sectional study was performed among the top 10 Swedish athletics athletes using 1 year prevalence of sports and non-sports injuries as the primary outcome measure. Associations with sociodemographic characteristics, lifetime abuse history and training load were investigated. Data were analysed using simple and multiple logistic regression models.
Results: 11% of 197 participating athletes reported lifetime sexual abuse; there was a higher proportion of women (16.2%) than men (4.3%) (P=0.005). 18% reported lifetime physical abuse; there was a higher proportion of men (22.8%) than women (14.3%) (P=0.050). For women, lifetime sexual abuse was associated with an increased likelihood of a non-sports injury (OR 8.78, CI 2.76 to 27.93; P<0.001). Among men, increased likelihood of a non-sports injury was associated with more frequent use of alcoholic beverages (OR 6.47, CI 1.49 to 28.07; P=0.013), while commencing athletics training at >13 years of age was associated with a lower likelihood of non-sports injury (OR 0.09, CI 0.01 to 0.81; P=0.032). Lifetime physical abuse was associated with a higher likelihood of sports injury in women (OR 12.37, CI 1.52 to 100.37; P=0.019). Among men, athletes with each parents with ≤12 years formal education had a lower likelihood of sustaining an injury during their sports practice (OR 0.37, CI 0.14 to 0.96; P=0.040).
Conclusions: Lifetime sexual and physical abuse were associated with an increased likelihood of injury among female athletes. Emotional factors should be included in the comprehension of injuries sustained by athletes.

Toomas Timpka, Staffan Janson, Jenny Jacobsson, Örjan Dahlström, Armin Spreco, Jan Kowalski, Victor Bargoria, Margo Mountjoy, Carl Göran Svedin

[link url=""]Linköpings University material[/link]
[link url=""]British Journal of Sports Medicine abstract[/link]

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