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knee - sport - trauma - sport medicine - exercise physiology - oxidative stress -
aging - skeletal muscle - german - english - translation - table tennis - racketsports
- physical education - minimum lactate - physiology - incidence - musculoskeletal
injury - sport - editorial office
Introduction
Musculoskeletal injuries (MSKIs) are injuries that can affect muscles, bones, and
joints and are commonly encountered in sports practice [1]
[2]. MSKIs are one of the most common
health-related injuries in athletes that results in economic costs, diminished
performance, and even withdrawal from competitions [3].
Table tennis, also known as ping-pong, is a racket sport played regularly by over
300
million people globally with at least 40 million federated players [4]. It may be used for physical education, recreation,
and therapeutic modality for various diseases [5]
[6]. Furthermore, table tennis attracts
participants of diverse ages, ranging from young athletes to older competitors [5]
[6]. However, it is a
complex sport that requires quick reflexes, rapid decision-making, and intricate
upper extremity rotations involving the wrist, elbow, and shoulder, as well as trunk
rotation and lower limb mobility with constant knee flexion [7]
[8]. Therefore, it is
believed that table tennis players are susceptible to MSKIs.
In the process of establishing an injury prevention strategy, knowledge of the risk
factors associated MSKIs is important. Previous systematic reviews have evaluated
the risk factors for MSKIs in other sports disciplines [9]. Although a descriptive study on MSKIs among high-performance players
has been published [10], no studies have provided a
comprehensive dataset on MSKIs in table tennis during competition. Therefore, this
study aimed to evaluate the characteristics of MSKIs in table tennis during
competition and identify the risk factors by comparing MSKI rates according to
player related variables.
Materials and Methods
Search strategy
This study was conducted according to the preferred reporting items for
systematic reviews and meta-analysis guidelines [11]. On December 7, 2021, we conducted a literature search in online
databases (PubMed, Embase, Web of Science) using different related search terms
as presented in [Table 1].
Table 1 Search strategy items and details
|
Database
|
Search terms
|
|
PubMed
|
((table tennis) OR (table tennis [MeSH Terms])) AND ((injury)
OR (injury[MeSH Terms]) OR (trauma) OR (trauma [MeSH
Terms]))
|
|
Embase
|
(‘table tennis’ OR ‘table
tennis’: ti, ab, kw) AND (injury OR injury: ti, ab,
kw OR trauma OR trauma: ti, ab, kw)
|
|
Web of Science
|
(ALL=(table tennis) OR TS=(table tennis)) AND
(ALL=(injury) OR TS=(injury) OR
ALL=(trauma) OR TS=(trauma))
|
Inclusion and exclusion criteria
The inclusion criteria included: (1) studies on MSKIs that occurred in table
tennis; (2) studies that defined injuries as new or recurring musculoskeletal
complaints, concussions, or other medical conditions (injuries) incurred in a
competition or training requiring medical attention, regardless of the resulting
absence from competition or training [12]; and
(3) studies written in English.
The exclusion criteria were as follows: 1) studies on non-MSKIs, diseases, or
other health problems in table tennis; 2) case reports; and 3) review articles.
However, for review articles, although they were not directly included in the
analysis, we added original articles cited within some review articles for our
analysis.
Data extraction and data analysis
We initially screened the results from the search string above based on a review
of the abstract or full text of each article, excluding studies that were
irrelevant. We obtained the full-text portable document format of the remaining
articles and reviewed them accordingly.
To compare the prevalence of MSKIs according to player-related characteristics,
we extracted information on sex, level of games, circumstances of injury, and
time loss from sport after injury as player-related variables. For risk factor
analysis, we classified each characteristic into subcategories. We classified
the level of games attended by players in each original article as Summer
Olympic Games, Asian Games, and domestic national games. Moreover, we classified
the circumstances of injury as the training or competition periods.
Statistical analysis
We calculated the odds ratio using the number of MSKIs according to
player-related variables. Data were analyzed using IBM SPSS ver. 20.0 (IBM
Corp., Armonk, NY, USA), and a p-value <0.05 was statistically
significant.
Results
Flowchart of the study selection process
[Fig. 1] shows the literature search, collection,
exclusion, and inclusion process. We included eight studies [13]
[14]
[15]
[16]
[17]
[18]
[19]
[20] in the
final analysis; the authors’ names, journal, year of publication, study
population size, level of games attended by players, and observation period for
each study are summarized in [Table 2].
Fig. 1 Flowchart of the study selection process.
Table 2 Main features of the included
studies
|
Authors
|
Journal (Year of publication)
|
No. of study population (Total / male /
female)
|
Level of games which players attended
|
Observational period (days)
|
|
A Hamid et al.
[13]
|
Sains Malaysiana (2016)
|
3 / 0 / 3
|
Asian Games
|
26
|
|
Engebretsen et al.
[14]
|
Br J Sports Med (2013)
|
174 / 86 /88
|
Summer Olympic Games
|
17
|
|
Junge et al.
[15]
|
Am J Sports Med (2009)
|
172 / 99 / 73
|
Summer Olympic Games
|
16
|
|
Laoruengthana et al.
[16]
|
J Med Assoc Thai (2009)
|
276 / 124 / 152
|
Thailand National Games
|
11
|
|
Lhee et al.
[17]
|
BMJ Open Sport Exerc Med (2021)
|
10 / 5 / 5
|
Asian Games
|
16
|
|
Nabhan et al.
[18]
|
Br J Sports Med (2016)
|
2 / 1 / 1
|
Youth Summer Olympic Games
|
13
|
|
Soligard et al.
[19]
|
Br J Sports Med (2017)
|
172 / 95 / 77
|
Summer Olympic Games
|
17
|
|
Steffen et al.
[20]
|
Br J Sports Med (2020)
|
64 / 32 / 32
|
Youth Summer Olympic Games
|
13
|
Study participants
Eight articles included 873 table tennis players, with 442 players
(50.6%) being male. Five articles involved 584 players who attended the
Summer Olympic Games, including the Youth Olympic Games; 13 players from two
articles attended the Asian Games; and 276 players from one article attended the
domestic national games.
Overall rate of musculoskeletal injuries
During competition, 31 MSKIs were reported among the 873 professional table
tennis players, and the overall rate of MSKIs in table tennis during competition
was 3.6%. [Fig. 2] shows the number of
professional table tennis players enrolled in each study and the total number of
MSKIs in each group. The incidence of table tennis-related MSKIs was 10.0
injuries per 1,000 playing hours (range, 0–27.0).
Fig. 2 Total number of table tennis players enrolled in each study
and total number of musculoskeletal injuries in that study.
Sex
Eight studies provided data on the sex distribution of players and [Fig. 3] shows the rate of MSKIs according to the
sex reported in each article. Overall, 14 MSKIs occurred in 431 female players,
and 17 MSKIs occurred in 442 male players. The rate of MSKIs for female and male
players were 3.2% and 3.8%, respectively, with no significant
difference (p=0.63).
Fig. 3 Number of injured table tennis players according to sex in
each study.
Level of games
[Fig. 4] shows the rate of MSKIs according to the
level of games reported in each article. The rate of MSKIs in each group was
4.8% (25 injuries/518 players) for the Summer Olympic Games,
15.4% (2 injuries / 13 players) for the Asian Games, and
0% (0 injuries/276 players) for the domestic national games. No
significant difference between the Summer Olympic Games and Asian Games was
observed (p=0.09).
Fig. 4 Rate of musculoskeletal injuries according to level of
games that players attended.
Circumstances of injury
Information on the circumstance of injury was available for 25 (80.6%)
injuries in five studies [13]
[14]
[15]
[19]
[20]. Of these,
13 (52.0%) occurred during training, and 12 (48.0%) during
competition.
Time loss from sport after injury
Data on time loss from sport after injury were available for 28 injuries
(90.3%) in six studies [13]
[14]
[15]
[17]
[19]
[20]. [Fig. 5]
shows the rate of MSKIs according to the time loss reported in each article. Of
the 28 injuries, 18 (64.3%) were injuries without time loss, and the
remaining injuries (35.7%) were injuries with time loss.
Figure 5 Number of musculoskeletal injuries according to time loss
from sport after injury.
Risk factors for musculoskeletal injuries
[Table 3] presents the odds ratios of MSKIs
according to player variables.
Table 3 Risk factors for musculoskeletal injuries in table
tennis
|
Player variables
|
Compare
|
Odds ratio
|
95% C.I
|
|
Male
|
Female
|
1.19
|
0.57–2.45
|
|
Asian Games
|
Summer Olympic Games
|
3.59
|
0.75–17.1
|
Discussion
This systematic review investigated the rate of MSKIs in table tennis during
competition. To the best of our knowledge, this is the first review to assess the
rate and risk factors of MSKIs among professional table tennis players. We found
that 31 MSKIs occurred in 873 professional table tennis players, and the incidence
of MSKIs in table tennis during competition was 10.0 injuries per 1,000 player
hours. However, no significant risk factors for MSKIs were observed in table tennis
during competition.
Kondric et al. [21] evaluated the frequency of sports
injuries among top Slovenian racket players and reported that table tennis players
experience fewer injuries compared to badminton and tennis players. Abadi et al.
[22] conducted a prospective cohort study during
professional tennis tournaments in Indonesia under the International Tennis
Federation and reported an MSKI incidence rate of 30.8 injuries per 1,000 playing
hours. In this study, the incidence rate of MSKIs in table tennis during competition
was 10.0 injuries per 1,000 playing hours, suggesting a lower incidence compared to
other racquet sports.
The rate of MSKIs in table tennis during competition may vary depending primarily
on
the definition of the injury, demographic characteristics of study participants, and
length of observation [23]. By exploring studies
conducted on a group of players with similar performance levels or participating in
the same game, a study of non-professional collegiate players reported MSKI rates
between 50.7% and 67.2%, whereas a study of world-class athletes who
participated in the Summer Olympic Games reported rates between 2.9% and
6.3% [14]
[15]
[19]
[24]
[25]. However, readers should keep in
mind that the study on MSKIs in world-class athletes only investigated MSKIs that
occurred during the Summer Olympic Games held for a brief period (16–17
days).
No significant differences in the total number of injuries, injury severity, and
incidence of injuries between non-professional players and professional athletes
were reported [26]
[27]
[28]. In a cross-sectional
epidemiological study of beach tennis injuries in 206 elite and recreational
players, the incidence of injuries in elite players was less than that in non-ranked
players (1.71 vs. 2.04 injuries/1,000 hours play) [26]. Nevertheless, Bahr and Krosshaug [29]
reported that the incidence of sports injuries in professional athletes was lower
than that in non-professional players. This review was aimed at studies that
analyzed MSKIs in professional table tennis athletes during competition. The reason
is that studies on non-professional athletes have often investigated injuries under
the athletes’ own judgment without using the definition of injuries used in
this study [12]. Therefore, to analyze the difference
in MSKIs between non-professional and professional table tennis players, it is
necessary to conduct a prospective study using the same definition of injuries.
A previous study that explored the epidemiology of sports-related injuries in young
athletes reported that 59.3% of injuries occurred during training and
40.7% during competitions [27]. At the 2012
Summer Olympic Games, a higher injury occurrence was reported during competition
than during training [14], whereas an opposite trend
was observed during the 2008 Summer Olympic Games [15]. However, the 2016 Summer Olympic Games and the 2018 Youth Summer
Olympic Games had the same number of MSKIs during training and competition [19]
[20]. Regarding
whether the risk of injury differs depending on the circumstance of injury, Kondric
et al. [21] suggested that the increase in MSKIs
during the competition period was due to increased risk factors, such as the
opponent, violation of fair play, and increased motivation.
This study had some limitations. First, this study provided only overall information
on MSKIs in table tennis; however, it could not provide information on the cause of
the injury, accurate diagnosis, and prevalence information according to the
diagnosis. Second, this study could not analyze the incidence of MSKIs according to
player age. This is because only four of the eight articles included in the analysis
presented the mean age of the entire population, and the above studies did not
separately describe the age of the injured player. Finally, we could not extract
information on important variables that were expected to be related to the risk of
musculoskeletal injury, such as a player’s career, athletic style
(attacking, defense, forehand stroke, and backhand stroke), usual amount of
training, and post-injury history.
However, this study has an advantage of being the first to systematically review
MSKIs that occur in professional table tennis players during competition and this
systematic review provides a comprehensive understanding of the MSKIs that occur in
table tennis during competition.
In conclusion, this systematic review provides valuable information about the MSKIs
in table tennis during competition. Because this study could not identify
injury-related risk factors, future research that analyzes comprehensive variables
is required.
