Associations between sport participation and knee symptoms: a cross-sectional study involving 3053 undergraduate students

Chan et al. BMC Sports Science, Medicine and Rehabilitation https://doi.org/10.1186/s13102-020-00169-w (2020) 12:20 RESEARCH ARTICLE Open Access Associations between sport participation and knee symptoms: a cross-sectional study involving 3053 undergraduate students Lloyd L. Y. Chan1*, Arnold Y. L. Wong2 and Maggie H. Wang3,4 Abstract Background: While a number of studies have investigated knee symptoms among elite athletes, few have directly compared the association between engagement in different sports and knee symptoms among young adults in the general population. The current study aimed to investigate the relation between sports participation hours, type/ number of sports engaged, self-rated competitiveness and knee symptoms among undergraduates. Methods: Undergraduates were invited to participate in a self-administered online survey through invitation emails. Respondents were instructed to provide demographic information (e.g., age, gender, sports participation hours, types of engaged sports, self-rated competitiveness in sports and anxiety level etc.) and to report knee symptoms (current, the last 7 days, the last 12 months, and lifetime). Multiple logistic regressions were conducted to investigate the association between sports participation and current knee symptoms. Results: Of 17,552 invitees, 3744 responded to the survey. Valid data from 3053 respondents was used for analysis. Forty-four percent of the respondents engaged in sports regularly (≥once per week). Running, cross-training and swimming were the most frequently participated sports among the respondents. The current prevalence rate of knee symptoms was 6.4%. Hours spent participating in combat sports, soccer, yoga, and basketball participation hours were significantly associated with current knee symptoms. Respondents who rated themselves as “competitive” demonstrated a higher risk of having current knee symptoms than “recreational” players. Number of engaged sports was not associated with current knee symptoms among undergraduates. Conclusions: Certain sports types were associated with current knee symptoms. Compared to self-rated “recreational” players, self-rated “competitive” players were more likely to have current knee symptoms. Students should take preventive measures to minimize their risk of developing knee symptoms, especially when participating in combat sports, soccer, yoga, and basketball, or engaging in sports at a highly competitive level. Keywords: Knee pain, Students, Sports, Youth sports injuries, Athletic injuries, Prevalence * Correspondence: 1 School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Chan et al. BMC Sports Science, Medicine and Rehabilitation (2020) 12:20 Background Given the well-known physical and mental health benefits of sports participation, [1, 2] many universities have introduced mandatory sports courses for undergraduate students. However, sports participation is also known to be the major activity leading to injuries that require hospitalization among people aged between 18 and 24 years [3]. A multi-center survey found that 23% of university students in China sustained sports injuries in the past 12 months [4]. Of various collegiate sports injuries, over one-third of them are related to the knee, rendering it to be the most commonly injured body part among undergraduates [5]. Since longer physical activity duration is related to more disabling knee pain among adolescents, [6] it is conceivable that a similar phenomenon may occur in undergraduates. Unfortunately, the relationship between sports participation and knee symptoms among undergraduates remains unclear because prior relevant research mainly focused on children/adolescents [7]. Some common causes of sports-related knee pain in adolescents (e.g., Osgood-Schalatter disease and SindingLarsen-Johannson disease) are rare among adults. Hence, findings among adolescents cannot be generalized to young adults. Knee pain in children and adolescents often persists, [8] and youth knee pain or sports-related knee injuries may increase the risk of future knee osteoarthritis, poor quality of life, and impaired dynamic balance [9, 10]. It is paramount to determine the influences of different sports on knee symptoms in young adults so that appropriate preventive strategies can be implemented. Recent literature suggests that intensive training in one sport with the exclusion of other sports (sports specialization) may increase the risk of overuse knee injuries, patellofemoral pain, patellar tendinopathy and OsgoodSchlatter disease among high school students [11–13]. However, it remains unclear whether the increased risk is attributed to a single sport participation or an intensive training and high level competition. Further, as previous literature only evaluated the impacts of sports specialization on adolescents, the relation between the number of sports participation or sports competitiveness and knee symptoms among undergraduates remains uncertain. Additionally, since previous studies only focused on the patterns of knee pain among elite athletes or used a broad term “physical activities” to investigate the relation between various sports activities and musculoskeletal pain, [6, 14] their findings cannot be generalized to a wider population nor be used to determine the effects of different sports activities on knee pain. Without relevant information, it is difficult to develop effective prevention strategies for young non-elite athletes. Page 2 of 8 Given the above, the present study aimed to: [1] investigate the relation between sports participation hours and current knee symptoms among undergraduates; and [2] determine whether the type and number of sports engaged, and/or self-rated competitiveness of sports enga (...truncated)