Introduction
and Objective:
COVID-19 lockdown orders were imposed on the entire Israeli population from 20March to 12May-2020. These had a major impact on sport activities. During this period, an abnormally high number of patients with indoor sport injuries arrived for orthopedic consultation. The purpose of this study was to characterize the modifications in physical activities (PA) that occurred during the lockdown, identify the related sport injuries, and to investigate lockdown-related risk factors associated with these injuries.
Methods
This was a cross-sectional observational study targeting the physically active Israeli population. During the last 2 weeks of the lockdown, an anonymous web-based survey was shared through social media using the “Snowball Sampling” method. Informed consent was waived by the ethics committee. Data collected included demographics, type/frequency of physical activity (PA) before/during lockdown, and incidence and characteristics of sports injuries. The sport injuries were self-reported. The severity of the injuries was determined according to the need of the patient to seek professional medical consultation or treatment during the lockdown since going out was prohibited excluding urgent medical treatment.
Results
415 individuals responded to the survey (205:210 female:male, age, mean±SD=38±15 years , range=11-75). Of the responders, 91% reported to be physically active twice a week or more before the lockdown, of which 82% reported that they remained at the same frequency of activity during the lockdown. However, the type of PA was modified relative to before the lockdown – PA at pools and gyms decreased to 10%, and group PA or those that required bikes/treadmills decreased to 50%. In contrast, individual activities near or at home, including running and power exercise with machines, were unchanged. Moreover, PA practiced at home with digital media such as aerobics and power exercises increased by 20%. Indeed, 77% of responders that practiced in groups before the lockdown were practicing alone during the lockdown (p<0.001 by McNemar). Sport injuries were reported by 108 of 415 (26%) of the respondents and occurred mostly indoors during intensive aerobics (38%) and power exercise (43%). The anatomical location of the majority of the injuries was the knees/ankles (57%), lower back (25%), and shoulders (16%). The male:female injury ratio was 1.6:1 (66:42)(p=0.011 by Chi-Square contingency). This is lower than the 3:1 ratio reported in the literature prior to the lockdown. Twenty-nine of 415 injured (7%) sought medical treatment despite the lockdown, attesting to the severity of their injury, of which 16 visits were to orthopedic clinic or emergency room (3.8%). Since this occurred during the 2-month lockdown, it extrapolates to a 23% potential annual incidence that is twice as much as the previously reported annual sport injury incidence of 3-13% outside of the lockdown period.
Conclusions
The sharp increase in incidence of injury and difference in gender-related injury ratio during the lockdown point to the need for additional public health evaluation of measures necessary for injury prevention during this period of imposed restrictions.