Epidemiology, etiology and prevention of injuries in competitive ice speed skating—limited current evidence, multiple future priorities: A scoping review

Abstract

Long‐track and short‐track ice speed skating are integral to the Winter Olympics. The state of evidence‐based injury prevention in these sports is unclear. Our goals were to summarize the current scientific knowledge, to determine the state of research, and to highlight future research areas for injury prevention in ice speed skating. We conducted a scoping review, searching all injury and injury prevention studies in competitive ice speed skaters. The six‐stage Translating Research into Injury Prevention Practice (TRIPP) framework summarized the findings. The systematic search yielded 1109 citations. Nineteen studies were included, and additional searches yielded another 13 studies, but few had high‐quality design. TRIPP stage 1 studies (n = 24) found competition injury rates from 2% to 18% of participants with various injury locations and types. Seasonal prevalence of physical complaints was up to 84% (for back pain) in long‐ and short‐track. Ten studies covered information on TRIPP stage 2, with two small etiological studies linking injuries to functional strength deficits (short‐track) and training load (long‐track). Questionnaire studies identified various perceived risk factors for injuries but lacked further scientific evidence. Most TRIPP stage 3 studies (five out of eight) focused on developing protective measures, while two studies found short‐track helmets performed poorly compared to helmets used in other sports. No study evaluated the efficacy, the intervention context, or the effectiveness (TRIPP stages 4–6) of the measures. Scientific knowledge on injury prevention in ice speed skating is limited. Future research should prioritize high‐quality studies on injury epidemiology and etiology in the sports.

1. INTRODUCTION

Ice speed skating has been integral to the Winter Olympic Games since 1924. It offers two different sports: long‐track and short‐track speed skating. Traditionally, long‐track speed skating is an individual time trial sport with races ranging from 500 to 5000 m (female)/10 000 m (male). It is organized as two athletes racing simultaneously in their lane on a 400 m track. Newer racing disciplines in long‐track ice speed skating are the mass start, the team pursuit and team sprint, in which skaters do not start in individual lanes and multiple athletes racing on the track simultaneously. Short‐track speed skating is a more tactical sport, where multiple athletes compete against each other on a 111.12‐m track in racing distances from 500 to 1500 m.

Regardless of the kind of sport, speed skating is a physiologically and technically highly demanding sport. Physiologically, a high degree of cardiovascular endurance and a high lower extremity muscular power output are required. Technically, the power is generated by a fast, lateral push‐off and transferred to the ice via the narrow blade in the skating‐specific crouched body position (i.e., small knee angle and horizontal trunk position), enabling forward velocities above 50 km/h in long‐track and above 45 km/h in short‐track speed skating. ¹ Both sports have similar training structures consisting of off‐ice training activities with different physical demands performed during the summer (e.g., road cycling, resistance training, jump training) and specific on‐ice training sessions carried out in the winter season. ² , ³

As for any athlete, having no physical complaint is also essential for ice speed skaters to train and perform optimally. In sport‐specific training sessions and competitions on‐ice, an increased occurrence of skating‐related injuries, such as groin problems or sudden onset contact injuries caused by falls, are reported. ⁴ However, high‐speed ice skating as an inciting factor is missing in the training phases off the ice, and different injury patterns can be expected. Here, repetitive gradual onset knee and lower back problems are also reported as physical complaints among ice speed skaters. ⁴ , ⁵ Therefore, it is important to prevent injuries by implementing effective training and competition routines and measures. To guide scientific projects in this direction, the Translating Research into Injury Prevention Practice (TRIPP) framework describes a six‐step approach in which, starting from a description of the injury problem (stage 1) and associated injury mechanisms and risk factors (stage 2), preventive measures are developed (stage 3) and scientifically evaluated (stage 4). This is followed by a description of the implementation context (stage 5) and the evaluation of the effectiveness of the measures in the sport context (stage 6). ⁶

In sports practice of ice speed skating, recommendations for using injury prevention measures can be found. For example, in the multiyear training concept for long‐track ice speed skating of the Dutch Speed Skating Federation (KNSB), injury prevention is given a top priority in the federation's stated vision for the physical development of athletes. ⁷ Various recommendations on measures to be used in training can be found from age 11/12 onwards, including, (i) exercises to improve mobility, trunk strength, as well as postural and movement control, (ii) regenerative measures (e.g., sports massage), and (iii) the support of sports physiotherapists, sports physicians, and athletic trainers. Another example in this context is the eLearning platform of the International Skating Union (ISU), where injury prevention is covered in various courses, for example as part of strength and conditioning training. ⁸

However, scientific speed skating‐specific knowledge on injuries (type, frequency, and severity), risk factors, and injury prevention measures have not been mapped out systematically, so we do not know where evidence‐based injury prevention stands in ice speed skating.

With this review, we had a threefold aim: (1) to map and synthesize the current injury and injury prevention knowledge in competitive ice speed skating, (2) to determine the current stages of injury prevention in ice speed skating, and (3) to highlight specific focus areas for further research and policymaking with regard to injury prevention in ice speed skating. Due to the limited amount of high‐level studies, a scoping review was the most appropriate methodology for reviewing the literature on competitive ice speed skating injury prevention.

2. METHODS

We followed the five stages for scoping reviews outlined in the framework proposed by Arksey and O'Malley ⁹ and further enhanced by Levac et al. ¹⁰ Additionally, we used the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) extension for Scoping Reviews (PRISMA‐Scr) ¹¹ as a guide for writing this review.

2.1. Scoping review stage 1: Identifying the research question

Using the elements Populations (ice speed skaters), Concepts (injury and injury prevention), and Contexts (all levels of competitive sports), ¹² we formulated the research question: “What is the current state of knowledge on injuries and injury prevention in competitive ice speed skating?”

We formulated this broad research question to include information on sudden and gradual onset and contact and noncontact injuries and their preventative measures. ¹³ We searched for relevant studies in elite and amateur competitive ice speed skaters because we believe it is valuable to review all contexts as preventative measures at one performance level may be integrated into another level.

2.2. Scoping review stage 2: Identifying relevant studies

We included the free text words “skating AND (injury OR injuries)” in an initial limited search and performed it on PubMed/MEDLINE (624 hits), SPORTDiscus (659 hits; all source types), and Google Advanced Search (first 300 hits). From the initial search, we screened the results for useful terms and keywords to be used in the review search, to identify the breadth of types of resources, and to estimate the extent of the scope of the review.

We found that “skating” as a free text word is included in many studies outside of the scope of this review, related to, for example, inline‐skating, figure skating, ice hockey, and skateboarding. Therefore, we decided to use “skating” OR “skater*” as the subject heading and terms such as “ice” OR “speed” OR “short‐track” to narrow down the population as well as terms such as “injur*” OR pain OR syndrome OR concussion to specifically search for context and concepts defined above in the review search. To ensure to include all relevant studies, we did not make further search specifications (with Boolean AND). We conducted the review search in Embase (Ovid) (1947‐), PubMed/MEDLINE (1946‐), SPORTDiscus (EBSCO) (1868‐), and ProQuest Dissertations & Theses Global on September 08, 2022. Specific final database searches can be found in Appendix S1. We screened reference lists of all included articles for potentially relevant studies. Gray literature and non‐systematic searches were carried out on SPORTDiscus (EBSCO) and ResearchGate (in Dutch, German, and English via advanced Google searches) and SPOLIT (access via www.bisp‐surf.de).

2.3. Scoping review stage 3: Study selection

We included all studies and reports with information on injuries and injury prevention in competitive ice speed skating (short‐track and long‐track ice speed skating) with adults or adolescents (12 years or older) and with no restrictions to region or setting, level of performance, sex, publication date, or publication language (the translation was requested if necessary). We excluded studies or reports when injuries were sustained in (community) ice rinks or on natural ice, if the focus was on other types of skating (figure skating, ice hockey, in‐line skating, cross‐country skiing, and skateboarding) or performance or biomechanics of skating was the sole focus. Also, we excluded case reports, narrative reviews, non‐peer‐reviewed opinion pieces, and newspaper and magazine articles. After removing duplicates, two reviewers (MH and AvdW) independently screened the eligibility of the remaining references via title and abstract. Both reviewers independently conducted a full‐text assessment for final inclusion. In case of disagreement between both reviewers, we consulted a third reviewer (PB) and initially differences were solved through discussion.

2.4. Scoping review stage 4: Charting the data

We created a data extraction table to collect information on publication details, ice speed skating sport, the study aims, samples, detailed methods, interventions (when applicable), results and relevant conclusions and reviewer comments. One reviewer (MH) extracted data from included studies which were checked for completeness and accuracy by a second reviewer (AvdW). If studies included combined data for both sports, or the sport was not further specified than “ice speed skating,” the authors were contacted with the request to specify the data or the skaters included.

2.5. Scoping review stage 5: Collating, summarizing and reporting the results

We organized the extracted information per ice speed skating sport into the six stages of TRIPP framework as outlines in the introduction. ⁶ This allowed us to map the data and conduct a specific descriptive and thematic analysis ¹⁴ to reveal the available evidence and gaps in injury and prevention knowledge in ice speed skating.

2.6. Risk‐of‐bias assessment

Finally, two reviews independently assessed the risk of bias for included epidemiology studies (TRIPP stage 1) using the 10‐criteria list previously employed in other sports injuries reviews. ¹⁵ , ¹⁶ , ¹⁷ A description of the criteria can be found in Table 1. Criteria were rated as 1 (i.e., low risk of bias) or 0 (i.e., high risk of bias) or N/A (not applicable), with a possible total score of 10. If, for example, one item was not applicable, the item was not rated, and a total score would be out of 9. After an independent assessment (MH, AvdW), we compared the results and discussed any differences.

TABLE 1.

Risk‐of‐bias assessment of studies on competitive ice speed skating injuries according to 10 criteria.

Study	Criteria risk‐of‐bias assessment										Final score
	1 a	2 a	3 a	4 a	5 a	6 a	7 a	8 a	9 a	10 a
Bernier et al., 2021	0	1	1	0	N/A	1	1	1	N/A	0	5/8
Brownlow & McCaig, 2021	0	0	1	0	N/A	0	1	UD	0	1	3/9
De Bruijn et al., 2018	1	0	0	0	N/A	0	1	1	0	0	3/9
Engebretsen et al., 2010	1	1	1	1	1	1	1	1	0	1	9/10
Fett et al., 2017	1	0	0	0	N/A	1	1	0	1	0	4/9
Gallo‐Vallejo et al., 2016	1	1	1	1	1	1	1	1	0	1	9/10
Okamura et al., 2014	1	0	0	0	N/A	1	1	0	0	0	3/9
Palmer et al., 2021	1	1	1	1	1	1	1	1	0	1	9/10
Palmer‐Green et al., 2014	1	1	1	1	UD	1	1	1	1	1	9/10
Quinn et al., 2003	1	0	1	0	N/A	1	1	0	1	0	5/9
Ruedl et al., 2012	1	1	1	1	1	1	1	1	0	1	9/10
Schmidt et al., 2014	1	0	0	0	N/A	1	1	0	0	0	3/9
Schulz et al., 2016	0	0	1	0	N/A	1	1	0	1	0	4/9
Shi et al., 2018	0	1	1	0	UD	1	1	1	1	0	6/10
Smasal, 1994	0	0	1	0	N/A	0	0	1	0	0	2/9
Snouse et al., 1999	1	0	1	0	N/A	0	1	1	0	1	5/9
Soligard et al., 2015	1	1	1	1	1	1	1	1	0	1	9/10
Soligard et al., 2019	1	1	1	1	1	1	1	1	0	1	9/10
Steffen et al., 2017	1	1	1	1	1	1	1	1	0	1	9/10
Takei et al., 2007	1	1	0	UD	N/A	1	1	1	N/A	0	5/8
Trompeter et al., 2018	1	0	0	0	N/A	1	1	0	1	0	4/9
Van Hilst et al., 2015	1	0	1	UD	N/A	1	1	0	1	0	5/9
Victoroff et al., 2009	0	1	1	UD	N/A	1	1	1	N/A	0	5/8

Note: Scoring: 1: low, 0: high.

Abbreviations: N/A, not applicable (not included in the sum of the maximum score); UD, unable to determine (counted as zero).

^a (1) Definition of MSI, (2) study design (3) description of skaters or type of skaters, (4) random sample selection process, (5) lost to follow‐up, (6) data collected directly from the speed skaters, (7) same mode of data collection, (8) diagnosis conducted by any physicians or any healthcare professional, (9) follow‐up period, and (10) incidence or prevalence rates of each MSI expressed by any ratio.

3. RESULTS

3.1. Descriptive results

Out of 826 unique citations from the systematic search, we selected 88 articles on full text and finally included 19 studies, consulting the third reviewer for 11 of these 19 studies. The study selection process and the primary reasons for exclusion are displayed in Figure 1 (PRISMA flow diagram).

FIGURE 1.

Flow diagram shows identified studies and included/excluded studies.

Overall, we included 32 studies, of which 19 specifically presented data on short‐track, 14 on long‐track. Six studies presented combined data for both sports, or the sport was not further specified than “speed skating”. Most sources (n = 22, 68%) were published as full‐text articles in peer‐reviewed journals, seven were conference proceedings, one was a book chapter, and one was a master thesis (no article available) (Figure 2). Study designs varied widely from retrospective medical chart reviews and questionnaires on past injuries to cross‐sectional physical assessment and laboratory‐based equipment testing to the prospective collection of medical data during (Youth) Olympic Games or complete seasons. Most studies (n = 23, 72%) described incidences or the prevalence of injuries and therefore concerned TRIPP stage 1. Information on the etiology of injuries (TRIPP stage 2) came from 10 studies (30%). The development of preventative measures was investigated in seven studies (TRIPP stage 3). No studies on TRIPP stages 4–6 were found (Figure 3). Of the 32 studies, 17 (52%) were published between 2015 and 2022. Most contributions came from researchers from Canada (n = 6), Germany (n = 6), and the Netherlands (n = 4). Data from eight publications were collected at international competitions, with six studies carried out at the Olympic Games or Youth Olympic Games.

FIGURE 2.

Publication type per sport. Note: (i) Seven studies contain separate information for long‐track and short‐track, respectively and are listed in both the short‐track and long‐track columns. (ii) The long/short‐track category contains studies that did not differentiate between sports in their data.

FIGURE 3.

Number of studies by study design in the TRIPP stages. Note: (i) Inside the circle, the six stages of the TRIPP framework are shown as originally described by Finch. (ii) Seven studies contain separate information for long‐track and short‐track, respectively and are listed in both the short‐track and long‐track columns. (iii) Eight studies contain information for multiple TRIPP stages listed in each corresponding stage. (iv) One study (Forbes et al. ¹⁸ ) includes qualitative research methods and computer simulations and is listed these two categories.

3.2. Thematic results

Tables S1–S8 provide a comprehensive and detailed overview of all included references and their findings, subdivided by sport and TRIPP stage with Tables S1–S3 presenting information on the location, type, and severity of injuries, if these were reported in the included studies.

3.2.1. Short‐track ice speed skating

TRIPP stage 1

Overall injury incidence rates of multiday racing events with elite adult or youth skaters (e.g., winter [Youth] Olympic Games) ranged from 3.2% to 18.3%, with no difference found between female and male skaters. ¹⁹ , ²⁰ , ²¹ , ²² , ²³ , ²⁴ , ²⁵ Two studies ²¹ , ²⁵ reported further details on the injuries, in 15 of the total 21 cases in these studies the assumed mechanism was sudden onset with varying injury sites and injury types. Further, an injury rate of 3.2% was reported among participating skaters in all levels of competitions (from regional to international). ²⁶

Four studies with varying study designs ⁴ , ²⁷ , ²⁸ , ²⁹ investigated injury incidence over a longer period in elite short trackers. Comparable incidence rates were found, indicating that, on average, nearly two out of three short‐track athletes get injured per season. The lumbar spine, knee, and thigh were consistently described as the most common regions of injury in three of these studies. ⁴ , ²⁷ , ²⁸ , ²⁹ Further evidence that the spine is a frequently injured region was provided by Schmidt et al. ³⁰ They reported a lifetime prevalence of back pain of 82.3% based on a survey of 17 German elite short‐track athletes. Snouse et al. ³¹ reported an incidence rate of lacerations of the lower leg in short trackers in the US‐Olympic training centers of 4.1/10 000 user days.

TRIPP stage 2

Factors associated with injuries were analyzed in four studies, ²⁶ , ²⁷ , ²⁸ , ³¹ with two studies regarding injury mechanisms occurring during on‐ice activities. Snouse et al. ³¹ found that self‐inflicted lacerations with an athlete's skate during a fall (80%) were more common than those from another athlete's skate (20%). Victoroff et al. ²⁶ identified passing maneuvers on a narrow track position as the most likely factor for the onset of injuries on the track. Palmer‐Green et al. ²⁷ described the most common causes of injury as follows: overuse (gradual/sudden‐onset: 38%), noncontact trauma (31%), and contact—static object (25%). The fourth study ²⁸ investigated the relationship between functional testing (Y‐Balance Test, knee isokinetic muscle strength test, etc.) at the beginning of the season and the occurrence of injuries during the season and found deficits in knee strength and core strength associated with subsequent knee and lower back injuries. In their recent study, Briand et al. ³² investigated noncontact injuries in Canadian female short‐track athletes. They monitored 40 variables (in the categories of: neuromuscular function, heart rate variability, training load, psychological well‐being, past injury type, and location) throughout two seasons. They developed and tested a random forest classifier model with these data to predict injuries in the upcoming 1–7 days. The authors concluded that including all variables in the model increased sensitivity and specificity compared to the inclusion of only training load‐related variables. The sensitivity and specificity of the model to forecast an injury within 1 or 2 days were above 0.5 and 0.7 respectively.

TRIPP stage 3

Three studies ³³ , ³⁴ , ³⁵ investigated the crash performance ability of helmets used in short‐track ice speed skating. Comparing short‐track helmets with helmets used in ice‐hockey and cycling in laboratory settings, ³³ , ³⁴ short‐track helmets performed poorer in reducing the impact of rotational and peak linear accelerations in almost all testing conditions. This leads the authors of these studies to question whether the helmets are adequate to protect athletes against concussions and mild brain injury.

TRIPP stages 4, 5, 6

No evidence was found for these stages in the TRIPP framework.

3.2.2. Long‐track ice speed skating

TRIPP stage 1

Overall injury incidence rates of multiday racing events with elite athletes or high‐level youth athletes ranged from 1.6% to 11.4%, with no difference found between female and male skaters. ¹⁹ , ²¹ , ²² , ²³ , ²⁴ , ²⁵ Two studies ²¹ , ²⁵ reported further details on the injuries, in 13 of the total 21 cases in these studies the supposed mechanism was sudden onset with varying injury sites and injury types.

In a large retrospective study published in 1990, Smasal ³⁶ analyzed medical records of 146 German national team skaters over an average 14‐year career period. He found that 81.5% of skaters (n = 119) suffered at least one injury at the lower (44%) and upper extremities (32%), trunk/pelvis (18%), and/or head (6%). The most common diagnoses were contusion (42%), muscle strain (17%), distortion (13%), and laceration (13%). He also reported that 28% of classified “overuse” injuries concerned lower back pain. ³⁶

We found data on back pain in three additional studies. ⁵ , ³⁰ , ³⁷ Two studies showed a comparable pattern regarding the occurrence and intensity of these complaints. Schulz et al. ³⁷ reported a 12‐month prevalence of back pain of 65%, with an average pain intensity of 4.9 on a 0–10 scale, and van Hilst et al. ⁵ present a 12‐month prevalence of low back pain of 60%, with an average pain intensity of 4.2 on a 0–10 scale. The lifetime prevalence of low back pain in a small group (n = 13) of adolescent German long‐track speed skaters was 85% (n = 11). ³⁰

TRIPP stage 2

Few studies investigated or provided information on possible causes of injuries, risk factors, or otherwise associated factors. Smasal ³⁶ found that a fall was the cause of 71% of all acute injuries registered in the medical records of elite German skaters. Forbes et al. ¹⁸ analyzed the mechanism of falls and the subsequent occurrence of an injury in a mixed‐design study. The authors identified different impact scenarios of the athletes into the protective boarding (sideways, backward, and forward) resulting from a fall in the corner and concluded that the remaining reaction time between the fall and the impact, as well as the body part that first impacts the boarding and the impact angle, appear to influence the injury type and severity resulting from a fall.

Two qualitative studies, one in speed skaters ⁵ and one in medical staff and health care professionals, ³⁸ revealed the typical skating posture and technique as a possible factor associated with low back pain and musculo‐skeletal complaints. Comparing these studies, skaters reported factors related to training mode (i.e., performing strength training), and medical staff reported factors related to mobility, stability, and coordination in the kinetic chain.

In a small group of elite speed skaters (n = 5), Cimbalnik and supervisors ³⁹ related a complaint index (weekly physical aches/pains and mental well‐being) to subjectively perceived training loads and strain (ratings on perceived exertion), finding positive relationships (regression coefficients between 0.35 and 0.71), suggesting higher training loads being associated with more physical complaints.

TRIPP stage 3

We found data on measures to prevent injuries in three sources. ⁵ , ¹⁸ , ⁴⁰ Expert interviews revealed that boarding characteristics should be optimally designed to prevent injuries from a fall and boarding crash. ¹⁸ The authors of this study then created computer simulations taking into account boarding properties (e.g., internal pressure and external friction of the boarding) and skaters' properties during a fall (impact posture, angle, and speed) to obtain insights that would allow the safety characteristics of the boarding to be further developed and provide skaters with advice on how to fall into these boarding preferentially. Skaters surveyed by Van Hilst et al. ⁵ performed core stability and abdominal muscle strengthening training and stretching exercises to reduce the risk of low back pain. Winter et al. ⁴⁰ performed the only TRIPP stage 3 randomized controlled trial in ice speed skating. They evaluated a 12‐week, 5 days per‐week off‐ice training program to increase ankle stability in adolescent speed skaters. As the main outcome, the intervention group improved dynamic balance on a relatively unstable off‐ice surface (Biodex Stability System) compared to the control group (no stability exercises).

TRIPP stages 4, 5, 6

No evidence was found for these stages in the TRIPP framework.

3.2.3. Short and long‐track ice speed skating—combined/undifferentiated data

TRIPP stage 1

Two studies used data on back pain and surveyed 33 German elite speed skaters. ⁴¹ , ⁴² Fett et al. ⁴¹ reported on lifetime (93.9%), 12‐month (84.4%), point (51.5%) prevalence of generalized back pain. For complaints in the last 3 months, the average intensity of the worst pain was 3.7 on an 11‐point numeric scale. Trompeter et al. ⁴² used the same dataset but highlighted the prevalence of low back pain: lifetime 82%, 12‐month 70%, point prevalence 39%. Two studies ⁴³ , ⁴⁴ provided data on injuries in elite adolescent speed skaters in Japan. Okamura et al. ⁴³ found fractures (10.7%), low back pain (10.1%), and ligament injuries (8.8%) as types of medically treated injuries most frequently reported by skaters. Lower back (27.8%), ankle (22.2%), and lower leg (16.7%) were the most frequently injured body regions found in medical checks in the study of Takei et al. ⁴⁴ de Bruin et al. ⁴⁵ reviewed the medical records of 698 patients diagnosed with lower leg chronic exertional compartment syndrome in a heterogeneous population in the Netherlands. They found that speed skating as a sport was associated with this specific injury (odds ratio: 5.85 [2.34–14.53], p < 0.01) and suspect that this is related to the typical skating posture.

TRIPP stage 3

In a laboratory study, Johnston ⁴⁶ reported on the design of a new test system to evaluate crash pad systems for both short‐ and long‐track ice‐rink. The peak deceleration and rebound properties of two short‐track pads (ISU pad, Calgary Olympic Oval pad) were compared as examples, with the Calgary Olympic Oval system at the time showing preferable characteristics.

TRIPP stages 2,4–6

No evidence was found for these stages in the TRIPP framework.

4. DISCUSSION

4.1. Thematic discussion

This scoping review has laid out the available evidence related to injuries and their prevention in ice speed skating following the six stages of the TRIPP model. We found published evidence for the first three stages only.

4.1.1. TRIPP stage 1

Injury incidences in long‐ and short‐track single and multiday race events fluctuated approximately between 2% and 18% of the participating athletes. They were relatively low compared to other winter sports included in these studies. ¹⁹ , ²⁰ , ²¹ , ²² , ²³ , ²⁴ , ²⁵ The prevalence of injuries and back pain analyzed over a longer period was, in contrast, relatively high, up to 64% for all injuries of included skaters short track, ⁴ , ²⁸ up to 65% for low back pain in one season in the long track ⁵ , ³⁷ and 84% for back pain in one season in long‐ and/or short‐track. ⁴¹ We analyzed the risk of bias for all included studies in TRIPP stage 1. Here, most prospective studies with a low risk of bias (scores: all 9/10) were conducted at Olympic Games or Youth Olympic Games ¹⁹ , ²¹ , ²² , ²³ , ²⁴ , ²⁵ and, therefore, only comprise evidence of injuries over a relatively short period. It should be noted that injury analyses around a season's peak only give a snapshot of the actual injury problem of the athlete, as gradual onset injuries are only considered to a small extent. However, the larger included studies with a longer observation period ⁴ , ³⁶ , ⁴³ had retrospective and self‐report designs with a high risk of bias (scores: 5/9; 3/9; 2/9). In these studies, the results on the mode of onset show that about 16% of the injuries in long track ³⁶ and 18% of the injuries in short‐track ⁴ were classified as gradual onset injuries. Although these numbers are consistent, when compared to a small, low‐risk‐of‐bias study included in this review (n = 11, RoB: 9/10), Palmer‐Green et al. ²⁷ found overuse as a cause of injury in 38% of the cases in short‐track. Recent long‐term prospective health surveillance studies in athletics found that gradual injuries accounted for 70% and 52.9% of all injuries. ⁴⁷ , ⁴⁸ This could indicate an underestimation of the prevalence of gradual onset injuries, as described in this review, due to recall bias in retrospective studies in the included studies. To summarize, although a considerable number of studies could be included at TRIPP stage 1, there is only limited high‐quality evidence for the incidence and characteristics of injuries around high‐level international competitions. For these competitions, it can be concluded that participation on average is relatively safe for the athletes. The focus for scientific projects should therefore be on a comprehensive description of the injury problem over a longer period in different age and performance categories.

4.1.2. TRIPP stage 2

Only a few small quantitative, prospective etiological studies were found. ²⁷ , ²⁸ , ³⁹ These studies provide very limited evidence on risk factors for gradual onset injuries. There are indications that functional strength deficits in the short‐track ²⁸ and the training load in the long‐track ³⁹ may be related to the development of these injuries. A fall on ice as an initiating factor for a sudden onset injury is only explicitly described by Smasal, ³⁶ where most documented injuries were caused by a fall. However, it must be emphasized that this study was published almost 30 years ago and includes retrospective data. Since then, the conditions for the athletes (indoor ice rinks, ice quality, and equipment) have changed fundamentally. As presented by Forbes et al., ¹⁸ fall analyses via computer simulations can be performed to update and analyze biomechanics and the impact of falls and subsequently (re)design protective equipment and fall strategies in TRIPP stage 3 studies.

Briand et al. ³² have developed and evaluated a statistical model to predict gradual onset injuries in short‐track by addressing training load as a potential factor in the etiology of this type of injury. Machine Learning analyses offer promising approaches to predicting the occurrence of severe injuries. ⁴⁹ This approach could be used as an effective tool to assist coaches in making decisions regarding the management of training load to protect the health of skaters. ⁵⁰ Medical professionals ³⁸ and skaters themselves ⁵ identified a variety of factors that can potentially increase the risk of injury in speed skaters, including the specific skating position, strength training, the explosive start of a race, lack of kinetic chain stability, muscle tension, and limited joint mobility. From a mechanical perspective, these factors, separately or in combination, could play a role in the development of repetitive sudden or gradual onset injuries. For example, in the working population, duration, extent and percentage of working time in flexed trunk body position (comparable to the typical skating position) are considered as a mechanical trigger for low back pain. ⁵¹ However, this association has not yet been investigated for speed skating. Further insights into the injuries and the mechanical and physiological demands of both summer season off‐ice training activities and the specific skating posture on the ice rink are required to fully understand the physical and mechanical training load in the etiology of gradual onset injuries in speed skating. ⁵² , ⁵³ , ⁵⁴

4.1.3. TRIPP stage 3

The main focus of the included studies in TRIPP stage 3 is testing the crash performance of approved helmets in short‐track. ³³ , ³⁴ , ³⁵ These were found to be inferior to helmets used in other sports (cycling and ice hockey), with the authors of these studies questioning the effectiveness of using these helmets in preventing head injuries in speed skating. For each preventive measure under TRIPP stage 3 (recommendations for the optimization of ice rink boarding, crash pads, helmet performance and impact posture during falls, a functional ankle stability program, and training components used to prevent LBP), there is no subsequent evidence that they can reduce the number or severity of injuries in skating.

4.2. Overall consideration

In this review, we used the TRIPP framework to organize and summarize the findings of the included studies. As shown in Figure 3, there is little evidence; where there is evidence (TRIPP stage 1 and 2), it is of varying quality or based on short follow‐up periods. Using the TRIPP framework, which outlines the road from an injury problem (stage 1; epidemiology) to effective prevention measures (stage 6; e.g., implemented effective evidence‐based prevention), ⁶ we need to “fill in the gaps” consecutively since it is a staged approach. This consecutive nature and continuity is not seen in competitive ice speed‐skating research. To stress this point, where there is evidence in a later TRIPP stage (i.e., TRIPP stage 3 studies on helmet development in short‐track), evidence on incidence and/or burden and etiology (i.e., TRIPP stages 1 and 2) of injuries to the head is lacking. And also, no follow‐up studies (TRIPP stage 4 onwards) on whether the designed preventative measures are effective have been published. As another example, although a high prevalence of (lower) back pain (TRIPP stage 1) was found in this review, there are almost no sport‐specific studies toward the development of preventive measures for (lower) back pain (TRIPP stages 2 and 3). Without a thorough understanding of the injury problem and a lack of internal consistency between the single TRIPP stages, it will not be possible to evaluate the efficacy (TRIPP stage 4) and effectiveness (TRIPP stage 6) of the preventive measures developed and implemented.

4.3. Evidence versus Practice

Scientific findings in the single stages of the TRIPP framework are sparse for both Olympic sports. Approaches to injury prevention in sport practice, illustrated in the introduction by the multiyear training concept for long‐track ice speed skating of the Dutch Speed Skating Federation (KNSB), ⁷ are therefore not or only partly based on published scientific evidence. This is also reflected in the regulations of the ISU regarding the equipment of skaters and the ice rinks at competitions, areas on which we included studies in this review. In the 2022 ISU “Special regulations and technical rules” for short‐track ⁵⁵ and long‐track ice speed skating ⁵⁶ two rules for each sport (280 and 291 for short‐track; 224 and 228 for long‐track) were considered relevant. These concern protective measures to prevent or reduce traumatic injuries at ISU Events and Winter Olympic Games and address requirements to (i) padding of the boarding, (ii) protective and cut‐resistant clothing and equipment, the use of helmets, and characteristics of skates and blades. Regular, complementary communications (No. 2400 for clothing and No. 2365 for padding) detail or update the related rules for short‐track. The most recent communication dates from December 17, 2020 (No. 2365), which updated a version from 2017 (No. 2185). In this review, however, the last scientific publication dates back to 2014. This, as well as the examples described from sports practice (multiyear training concept and ISU eLearning platform), indicate that, at the level of the associations and in the field, research gaps identified above might already be filled with experience‐based knowledge. Consequently, implemented injury prevention measures are not only partially and indirectly based on scientific evidence regarding epidemiology, etiology, and the effectiveness of interventions. This leads to a clear call for further scientific studies in both Olympic sports.

4.4. Priorities and recommendations

We recommend high‐quality research projects to fill the knowledge gaps and, if possible, evaluate existing experience‐based knowledge in the field. Based on the results of this review, we have summarized priorities and recommendations for future research projects on injury prevention in short‐track and long‐track speed skating in Table 2.

TABLE 2.

Opportunities and recommendations for future research priorities for injury prevention in speed skating based on the TRIPP framework as well as research areas and findings of studies included in this review.

TRIPP stage/topic	Focus	Relevance	How
TRIPP stage 1—Injury surveillance long‐track and short‐track	Implementation of sport‐specific injury surveillance systems Description of the incidence and burden of injuries (sudden and gradual onset) throughout an entire season (at least)	High‐quality data only short‐term (competitions), lack of long‐term data, gradual onset injuries underrepresented. Very limited evidence of injury severity and burden Foundation for TRIPP stage 2, well‐running injury surveillance systems (e.g., at the level of national federations) as a basis for TRIPP stage 6 analyses	Large prospective cohort studies to be conducted at the level of national associations, including athletes of different performance levels (amateur, talented, and elite) Data collection and report according to recent general recommendations 13 , 57 extended by sport‐specific characteristics (cf.: Ref. 58) Stakeholder involvement
TRIPP stage1—Competition injuries	Description of the incidence and burden of (international) competitions	Competition rules include requirements for the protective equipment of athletes, and the track, development, and effectiveness (TRIPP stage 6) of these measures must be based on long‐term analysis of frequency, type, and severity of injuries at competitions	Injury registration at official (international/national) competitions. Use standardized sport‐specific injury report form (cf.: Ref. 59) A central database at the international federation (as a rule‐setting body)
TRIPP stage 2—Etiological studies	Analysis of training load in the etiology of injuries	Training load as a factor in the onset of injuries was investigated in some studies. Deeper insights into the mechanical and physiological demands of the summer and winter season training activities are needed to comprehensively understand the association between physiological and mechanical training load and injuries 52	Cross‐sectional analyses to identify high mechanical loads in speed skating training and competition routine, laboratory studies initiated by scientists Prospective etiological studies to identify individual training and competition load profiles (physiological and mechanical) in association with occurrences of injuries
TRIPP stage 2—Fall mechanisms	Updated analysis of falls as a mechanism of injury	Studies on injury frequencies caused by a fall date back many years, but both sports have evolved The fall mechanisms that lead to injuries must be understood to develop protective materials effectively	Systematic video analysis of crashes at competitions to compare with injury consequences (cf.: Ref. 18) Prospective, standardized injury registration at the training sites records injuries in the event of falls during training sessions (cf.: Ref. 31) Computer simulations (cf.: Ref. 18)
TRIPP stage 2—Screening	Musculo‐skeletal screening	Indications of a relationship were found in this review and needed to be verified in larger populations, at closer time intervals and in the long‐track speed skating	Prospective etiological studies that incorporate moderating/mediating effects
TRIPP stage 3—Injury prediction and decision‐making	Statistical prediction modeling	Advanced statistical modeling based on machine learning approaches is innovative. This review reported for short‐track, lacking for long‐track It could be used to develop preventive measures by supporting coaches in decision‐making in training load management Decision‐making strategies need to be developed	Comparable to Briand et al., 32 included in this review A possible framework to extend the statistical models into preventive measures can be found here 60
TRIPP stage 3—General consideration	Development of measures specifically based on findings in the preceding TRIPP stages and the practical experience of stakeholders (TRIPP stage 5)	The measure should be directed at a previously identified problem Expert knowledge from the beginning to determine the type and scope of measures	Initiatives from scientists together with national federations to include the widest possible range of stakeholders
TRIPP stage 4—General consideration	Subsequent evaluation of the efficacy of developed measures		High‐quality research: Randomized controlled trials or quasi‐experimental/time series approaches initiated at the level of federations
TRIPP stage 5—Context‐driven perspectives	Description of relevant facilitators and barriers of planned measures (before and after implementation) Stakeholder engagement	Measures must meet with broad user support to be implemented efficiently For this purpose, a participatory, bottom‐up approach is recommended	Qualitative research approaches 61 Integrated into the previous TRIPP stages, in particular, stage 3
TRIPP stage 6—Evaluation of implemented rules	Evaluation of the effectiveness of measures formulated in official rules and regulations to prevent injuries in their context.	Rules are regularly updated, and findings on this influence on the injury frequencies and severity could not be identified via this review	Analysis based on numbers in TRIPP stage 1 recommendation: Injury registration at official (international/national) competitions. (cf.: Ref. 62 )

4.5. Limitations

This scoping review aims to provide a comprehensive and broad representation of the existing literature, irrespective of the quality and publication date of the studies included. Results from conference proceedings, studies with retrospective and cross‐sectional designs, different injury registration and definition methods, and studies with a high risk of bias have been included. Older studies can only partially reflect the dynamics with which sports have evolved. Therefore, this review is only partially suitable for implementing evidence‐based recommendations in current training practice. Rather, it outlines the lack of evidence and systematic approach to injury prevention in ice speed skating. Although we have presented the results from all available scientific literature in the competitive world of ice speed skating in which not all knowledge and practices may be shared in research or public information sources, we cannot be sure that all available scientific knowledge on this topic has been included.

5. CONCLUSION

The current state of knowledge on injuries and injury prevention in speed skating in the individual stages of the TRIPP framework is limited and only partially builds on each other. Scientific evidence on the efficiency and effectiveness of preventive measures is not available. The underlying knowledge for the development of preventive measures, in particular that on the epidemiology and etiology of injuries, is incomplete. With limited evidence on sport‐specific prevention measures no ice speed skating practice recommendations can be made.

6. PERSPECTIVE

Multiple future research priorities for injury prevention research emerge. To establish a stringent approach in skating‐specific injury prevention, we recommend prioritizing single projects according to the stages of the TRIPP framework research, starting with research on injury epidemiology and etiology. In addition, we recommend continuously incorporating findings from TRIPP stage 5 (description of the intervention context to inform implementation strategies) into the design and implementation of research projects at the first TRIPP stages. Here, the assumed, diverse and broad experience‐based knowledge in the field could be used to design injury surveillance systems to be used in epidemiological studies, to select potential risk factors and mechanisms to be tested in etiological studies and, finally, to design structured injury prevention program to be tested in clinical studies. These participatory research approaches will enable context‐driven perspectives, which, in turn, will provide a more comprehensive view of the complex injury problem and thus lead to effective solutions. ⁶³ In addition, we recommend considering an injury‐specific approach. Effective injury prevention measures for severe or prevalent injuries in the ice speed skating (TRIPP stage 1 results) could be adopted from comparable sports, adapted to the context of the ice sports (TRIPP stage 5) and be to develop (TRIPP stage 3) and subsequently evaluate (TRIPP stage 4) injury prevention measures in ice speed skating.

AUTHOR CONTRIBUTIONS

Matthias Hendricks, Evert Verhagen, and Alexander T. M. van de Water were responsible for the conception of the study. Matthias Hendricks executed the search strategy and extracted the data with the supervision of Alexander T. M. van de Water. Matthias Hendricks and Alexander T. M. van de Water reviewed the records, assessed the risk of bias independently and were responsible for the first draft of the manuscript. All authors contributed to the interpretation of the findings, critical revision of the manuscript, reviewed and approved the final manuscript.

FUNDING INFORMATION

No funding was received for the preparation of this manuscript.

CONFLICT OF INTEREST STATEMENT

Matthias Hendricks, Evert Verhagen, and Alexander T. M. van de Water declare that they have no conflicts of interest.

Supporting information

Appendix S1.

Tables S1–S8.

Hendricks M, Verhagen E, van de Water ATM. Epidemiology, etiology and prevention of injuries in competitive ice speed skating—limited current evidence, multiple future priorities: A scoping review. Scand J Med Sci Sports. 2024;34:e14614. doi: 10.1111/sms.14614

DATA AVAILABILITY STATEMENT

All data are available in the manuscript or in the online supplementary information.