Subscribe to RSS
DOI: 10.1055/a-2403-9752
Research on Injury Risk of Elite Male Athletes in Racing Ice Sports based on Blood Indexes
Funding Information
Ministry of Science and Technology of China — 2019YFF0301704

Abstract
This study aims to explore the relationship between blood biochemical indexes and injury risk for elite male athletes in racing ice sports. The study compared the demographic indexes, monthly injuries, and longitudinal tracking data for the athletes. The non-linear relationship was analyzed using an unrestricted cubic spline. Generalized estimating equations were used to estimate the relative risk (OR) of injury occurrence. Receiver operating characteristics and the area under the curve determined diagnostic accuracy. In the snow sledding group, when creatine kinase rises to 489.46 u/L or testosterone decreases to 41.32 ng/ml, the risk increases by 1.70 times (OR=1.70, p<0.001) and 1.69 times (OR=1.69, p<0.001) with statistical significance. The creatine kinase (OR=1.01, P=0.007) and testosterone (OR=1.00, P<0.001) were included in the injury prediction model. The model exhibits excellent discrimination, with sensitivity and specificity of 82.8% and 86.5%, respectively. In the ice skating group, when creatine kinase rises to 467.00 u/L, the risk increases by 2.56 times with statistical significance (OR=2.56, p<0.001). Creatine kinase (OR=1.01, P<0.001) was included in the predictive model. The model demonstrates good discrimination, with sensitivity and specificity of 90.5% and 66.7%, respectively. Creatine kinase and testosterone are the risk predictors of injury in elite snowmobile male athletes. Creatine kinase is an independent risk factor for injury in elite speed skaters.
Publication History
Received: 03 May 2024
Accepted: 26 August 2024
Accepted Manuscript online:
26 August 2024
Article published online:
27 August 2025
© 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness: Treatment strategies and performance factors. Sports Med 2003; 33: 145-164
- 2 Coppalle S, Rave G, Ben Abderrahman A. et al. Relationship of Pre-season Training Load With In-Season Biochemical Markers, Injuries and Performance in Professional Soccer Players. Front Physiol 2019; 10: 409
- 3 Bittencourt NFN, Meeuwisse WH, Mendonça LD. et al. Complex systems approach for sports injuries: Moving from risk factor identification to injury pattern recognition-narrative review and new concept. Br J Sports Med 2016; 50: 1309-1314
- 4 Finsterer J. Biomarkers of peripheral muscle fatigue during exercise. BMC Musculoskelet Disord 2012; 13: 218
- 5 Stajer V, Vranes M, Ostojic SM. Correlation between biomarkers of creatine metabolism and serum indicators of peripheral muscle fatigue during exhaustive exercise in active men. Res Sports Med 2020; 28: 147-154
- 6 Hartmann U, Mester J. Training and overtraining markers in selected sport events. Med Sci Sports Exerc 2000; 32: 209-215
- 7 Andrzejewski M, Podgórski T, Kryściak J. et al. Anabolic-catabolic hormonal responses in youth soccer players during a half-season. Res Sports Med 2021; 29: 141-154
- 8 Kraemer WJ, Ratamess NA, Hymer WC. et al. Growth Hormone(s), Testosterone, Insulin-Like Growth Factors, and Cortisol: Roles and Integration for Cellular Development and Growth With Exercise. Front Endocrinol (Lausanne) 2020; 11: 33
- 9 Tessitore A, Meeusen R, Pagano R. et al. Effectiveness of active versus passive recovery strategies after futsal games. J Strength Cond Res 2008; 22: 1402-1412
- 10 Hackney AC. Hypogonadism in Exercising Males: Dysfunction or Adaptive-Regulatory Adjustment?. Front Endocrinol (Lausanne) 2020; 11: 11
- 11 Yang M, Tian Y, Zhao J. The physiological and biochemical analysis of China marathon team preparing for Berlin World Athletics Championships. China Sport Science and Technology 2011; 47: 21-25
- 12 Liu H, Li J, Yang M. et al. Analysis of sports injuries from winter Olympic and winter youth Olympic games. China Sport Science and Technology 2020; 26: 1209-1216
- 13 Clarsen B, Pluim BM, Moreno-Pérez V. et al. Methods for epidemiological studies in competitive cycling: An extension of the IOC consensus statement on methods for recording and reporting of epidemiological data on injury and illness in sport 2020. Br J Sports Med 2021; 55: 1262-1269
- 14 Moghadam-Kia S, Oddis CV, Aggarwal R. Approach to asymptomatic creatine kinase elevation. Cleve Clin J Med 2016; 83: 37-42
- 15 Marqués-Jiménez D, Calleja-González J, Arratibel I. et al. Are compression garments effective for the recovery of exercise-induced muscle damage? A systematic review with meta-analysis. Physiol Behav 2016; 153: 133-148
- 16 Fu R, Liu C, Sun X. Overview of researches on the homeostasis of exercise-induced skeletal muscle damage. journal of Physical Education 2011; 18: 133-138
- 17 Bessa AL, Oliveira VN, Agostini GG. et al. Exercise Intensity and Recovery: Biomarkers of Injury, Inflammation, and Oxidative Stress. J Strength Cond Res 2016; 30: 311-319
- 18 Clarkson PM, Byrnes WC, Gillisson E. et al. Adaptation to exercise-induced muscle damage. Clin Sci (Lond) 1987; 73: 383-386
- 19 He Z, Zhang C, Wen F. et al. Early-warning threshold of blood markers for overtraining in elite female wrestlers. China Sport Science and Technology 2018; 54: 45-51
- 20 Horta TAG, Bara Filho MG, Coimbra DR. et al. Training Load, Physical Performance, Biochemical Markers, and Psychological Stress During a Short Preparatory Period in Brazilian Elite Male Volleyball Players. J Strength Cond Res 2019; 33: 3392-3399
- 21 Yang Y, Ge X. Creatine kinase and sports training. Journal of Wuhan Sports University 1999; 82-85
- 22 Yuan Q. The monitoring function of serum creatine kinase in sports training. Journal of Physical Education 2007; 40-43
- 23 Zhang Y, Zheng P, Shi J. et al. Associations of ambient temperature with creatine kinase MB and creatine kinase: A large sample time series study of the Chinese male population. Sci Total Environ 2023; 880: 163250
- 24 Hong JH, Kim HJ, Kim KJ. et al. Comparison of metabolic substrates between exercise and cold exposure in skaters. J Physiol Anthropol 2008; 27: 273-281
- 25 Mäkinen TM, Rintamäki H, Karpakka J. et al. Submaximal exercise in the cold: Does cooling potentiate the development of muscle injuries in the rat?. Comp Biochem Physiol A Mol Integr Physiol 1998; 121: 273-278
- 26 Terblanche SE, Masondo TC, Nel W. Effects of cold acclimation on the activity levels of creatine kinase, lactate dehydrogenase and lactate dehydrogenase isoenzymes in various tissues of the rat. Cell Biol Int 1998; 22: 701-707
- 27 Nanavati K, Rutherfurd-Markwick K, Lee SJ. et al. Effect of curcumin supplementation on exercise-induced muscle damage: A narrative review. Eur J Nutr 2022; 61: 3835-3855
- 28 Caballero-García A, Pascual-Fernández J, Noriega-González DC. et al. L-Citrulline Supplementation and Exercise in the Management of Sarcopenia. Nutrients 2021; 13: 3133
- 29 Vollaard NB, Shearman JP, Cooper CE. Exercise-induced oxidative stress: Myths, realities and physiological relevance. Sports Med 2005; 35: 1045-1062
- 30 Barnett A. Using recovery modalities between training sessions in elite athletes: Does it help?. Sports Med 2006; 36: 781-796
- 31 Soligard T, Schwellnus M, Alonso JM. et al. How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury. Br J Sports Med 2016; 50: 1030-1041
- 32 Meeusen R, Duclos M, Foster C. et al. Prevention, diagnosis, and treatment of the overtraining syndrome: Joint consensus statement of the European College of Sport Science and the American College of Sports Medicine. Med Sci Sports Exerc 2013; 45: 186-205
- 33 Ammar A, MounaTurki, Trabelsi K et al. Effects of natural polyphenol-rich pomegranate juice on the acute and delayed response of Homocysteine and steroidal hormones following weightlifting exercises: a double-blind, placebo-controlled trial. J Int Soc Sports Nutr 2020; 17: 15
- 34 Crewther B, Witek K, Draga P. et al. Short-Term d-Aspartic Acid Supplementation Does Not Affect Serum Biomarkers Associated With the Hypothalamic-Pituitary-Gonadal Axis in Male Climbers. Int J Sport Nutr Exerc Metab 2019; 29: 259-264
- 35 Lausen A, Broering C, Penke L. et al. Hormonal and modality specific effects on males’ emotion recognition ability. Psychoneuroendocrinology 2020; 119: 104719
- 36 Gharahdaghi N, Phillips BE, Szewczyk NJ. et al. Links Between Testosterone, Oestrogen, and the Growth Hormone/Insulin-Like Growth Factor Axis and Resistance Exercise Muscle Adaptations. Front Physiol 2020; 11: 621226
- 37 Jin L, Yuan X. Special physical training research on Chinese skeleton and bobsleigh team. Journal of Harbin Sport University 2020; 38: 27-32
- 38 Vingren JL, Kraemer WJ, Ratamess NA. et al. Testosterone physiology in resistance exercise and training: The up-stream regulatory elements. Sports Med 2010; 40: 1037-1053
- 39 Kraemer WJ, Ratamess NA, Nindl BC. Recovery responses of testosterone, growth hormone, and IGF-1 after resistance exercise. J Appl Physiol (1985) 2017; 122: 549-558
- 40 MacLean HE, Chiu WS, Notini AJ. et al. Impaired skeletal muscle development and function in male, but not female, genomic androgen receptor knockout mice. Faseb j 2008; 22: 2676-2689
- 41 Kvorning T, Andersen M, Brixen K. et al. Suppression of endogenous testosterone production attenuates the response to strength training: A randomized, placebo-controlled, and blinded intervention study. Am J Physiol Endocrinol Metab 2006; 291: E1325-E1332
- 42 Crewther BT, Cook C, Cardinale M. et al. Two emerging concepts for elite athletes: The short-term effects of testosterone and cortisol on the neuromuscular system and the dose-response training role of these endogenous hormones. Sports Med 2011; 41: 103-123
- 43 Morris KL, Widstrom L, Goodrich J. et al. A Retrospective Analysis of Collegiate Athlete Blood Biomarkers at Moderate Altitude. J Strength Cond Res 2019; 33: 2913-2919
- 44 Ziemba A, Adamczyk JG, Barczak A. et al. Changes in the Hormonal Profile of Athletes following a Combat Sports Performance. Biomed Res Int 2020; 2020: 9684792
- 45 Kilianski J, Peeters S, Debad J. et al. Plasma creatine kinase B correlates with injury severity and symptoms in professional boxers. J Clin Neurosci 2017; 45: 100-104
- 46 Xizhang H, Gao B. Constructing a Diagnosis Model and Visualizing the Risk Relationship between Biomarkers and Overuse Injuries in Well-trained Wrestlers. Int J Sports Med 2023; 44: 642-649
- 47 Cho E, Lemoine N, Theall B. et al. Identification Of Blood Biomarkers Of Mild Traumatic Brain Injury In Collegiate Football Players. Medicine & Science in Sports & Exercise 2019; 51: 740
- 48 Kohn MA, Newman TB. The walking man approach to interpreting the receiver operating characteristic curve and area under the receiver operating characteristic curve. J Clin Epidemiol 2023; 162: 182-186
- 49 Nezic DG. Assessing the performance of risk prediction models. Eur J Cardiothorac Surg 2020; 58: 401-401
- 50 Wang N, Lv L, Yan F. et al. Biomarkers for the early detection of pressure injury: A systematic review and meta-analysis. J Tissue Viability 2022; 31: 259-267
- 51 Kim EJ, Wierzbicki AS. Investigating raised creatine kinase. BMJ 2021; 373: n1486
- 52 Bouzigon R, Dupuy O, Tiemessen I. et al. Cryostimulation for Post-exercise Recovery in Athletes: A Consensus and Position Paper. Front Sports Act Living 2021; 3: 688828
- 53 Kusmierczyk J, Wiecek M, Bawelski M. et al. Pre-exercise cryotherapy reduces myoglobin and creatine kinase levels after eccentric muscle stress in young women. Front Physiol 2024; 15: 1413949
- 54 Erlacher D, Ehrlenspiel F, Adegbesan OA. et al. Sleep habits in German athletes before important competitions or games. J Sports Sci 2011; 29: 859-866
- 55 Foster RG. Sleep, circadian rhythms and health. Interface Focus 2020; 10: 20190098
- 56 Wardenaar FC, Ceelen IJM, Van Dijk J-W. et al. Nutritional Supplement Use by Dutch Elite and Sub-Elite Athletes: Does Receiving Dietary Counseling Make a Difference?. Int J Sport Nutr Exerc Metab 2017; 27: 32-42
- 57 Knapik JJ, Steelman RA, Hoedebecke SS. et al. Prevalence of Dietary Supplement Use by Athletes: Systematic Review and Meta-Analysis. Sports Medicine 2016; 46: 103-123