Research Articles (Physiotherapy)

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Navigating adversity : non-completion and evacuation of trail runners at the 2022 Magoebaskloof Forest Marathon
Maleka, Thabo; Jansen van Rensburg, Audrey; Viljoen, Carel Thomas; Ramkilawon, Gopika Devi; Ramagole, Dimakatso Althea; Nair, Anoop; Janse van Rensburg, Dina Christina (South African Sports Medicine Association, 2026-04-22)
BACKGROUND : Trail running occurs on natural, uneven terrain. The literature is limited in exploring factors that contribute to trail runners not completing a race. OBJECTIVES : This study firstly investigated self-reported reasons for runners who did not finish (DNF) the 2022 Magoebaskloof Forest Marathon across 10km, 20km, 34km, and 50km distances, and secondly assessed runners' evacuation methods. METHODS: A descriptive cross-sectional study of consenting trail runners (n=429) who completed the post-race DNF survey (10km, 20km, 34km and 50km distances). Within two weeks post-race, runners reported whether they finished, reasons for discontinuing and evacuation methods. We report numbers (n) and point prevalence (%). RESULTS : Of the 228 runners who completed the post-race survey, 16 (7%) DNF. DNF runners entered the 34 km (19%) and 50 km distance (81%) and were aged 31–50 years (94%). No DNFs occurred in the 10km and 20km races. Approximately 27% did not meet cut-off times, while 19% got lost despite trail directions. Other contributing factors included pre-existing and new injuries (23%), illnesses (15%), and inadequate training (8%). While 50% of the DNF group had >5 years total running experience, only 19% had >5 years of trail running experience. Runners who finished the trail race had significantly more trail running experience than those who DNF (p=0.0082). The primary evacuation method was hiking back to the nearest aid station (63%), with 19% subsequently transported by shuttle. CONCLUSION : Multiple factors may have contributed to the race non-completion. Many DNF runners started with injuries or illnesses, inadequate training, or limited trail-running experience. Event planners should improve measures to prevent runners from getting lost. These findings emphasise the importance of preparation, navigation skills, and race management in ensuring trail running safety and success.
Prevalence of self-reported shoulder pain and shoulder function among uninjured CrossFit athletes in Pretoria, South Africa
Dawood, Muhammad; Meyer, Edwin Ernest; Moatshe, Tshegofatso Prudence (South African Sports Medicine Association, 2026-06-22)
BACKGROUND: CrossFit is a rapidly growing sport characterised by high-intensity functional movements that place substantial demands on the shoulder complex. Although shoulder injuries are frequently reported, the prevalence of self-reported shoulder pain and shoulder function among uninjured CrossFit athletes remains unclear. OBJECTIVES: To determine the prevalence of self-reported shoulder pain and to describe shoulder function among uninjured CrossFit athletes in Pretoria, Gauteng. METHODS : A cross-sectional study was conducted among CrossFit athletes recruited from gyms in Pretoria. Participants completed a sociodemographic and training questionnaire. Pain presence and severity were assessed using the Numeric Pain Rating Scale (NPRS), based on current shoulder pain intensity. Shoulder function was assessed using the Penn Shoulder Score (PSS). Descriptive statistics (means, standard deviations, frequencies, and percentages) were used to summarise the data. Chi-square tests were used to explore associations between shoulder pain and selected demographic and training-related variables. RESULTS : Sixty-eight participants provided valid responses for pain analysis, while all participants completed the PSS. The prevalence of self-reported shoulder pain was 76% (95% CI: 64%-85%), with a mean NPRS score of 2.97 ± 2.75/10, indicating predominantly low-intensity pain. Shoulder function was generally preserved, with a mean total PSS of 87.8 ± 12.2 (out of 100). Shoulder pain was significantly associated with previous shoulder injury (p < 0.05). No significant associations were found between demographic or training-related variables and shoulder function. CONCLUSION : Self-reported shoulder pain is highly prevalent among uninjured CrossFit athletes despite largely preserved shoulder function. These findings suggest that athletes may continue training despite experiencing pain, highlighting the importance of routine screening and early intervention strategies.
The undergraduate external examination process and the perceptions of examiners at the physiotherapy departments in South Africa
Ntsiea, Mokgobadibe V.; Mostert, Karien; Titus, Adnil; Joseph, Conran; Manie, Shamila; Van Wyk, Heleen; Tshabalala, Muziwakhe; Chetty, Verusia (AOSIS, 2026-06-26)
BACKGROUND : Variations in external examination processes across South African universities may challenge the validity of physiotherapy assessments. Our study explores external examiners’ understanding of moderation and academic standards. OBJECTIVES : This study aimed to describe the examination processes and external examiners’ perceptions of academic standards in South African physiotherapy programmes. METHOD : A descriptive cross-sectional survey using a self-administered questionnaire sent to all eight universities that offer a physiotherapy degree in South Africa. The total population size was 103. RESULTS : Practices include appointing the same external examiner for up to 2 years (n = 4), using the same examiner for reassessments (n = 3), and assigning examiners across all modules regardless of expertise (n = 2). Five institutions allocate clinical blocks specifically, and four expose students to all clinical areas. External examiners assess all third- and fourth-year students at five institutions and receive procedural orientation via written guidelines (n = 5). Feedback is typically shared orally (n = 5) or in a university-formatted written report (n = 3). A 10% mark difference is acceptable at two institutions; others lack clear criteria. Internal and external marks carry equal weight, and two universities apply sub minima for clinical safety and effectiveness. Moderation samples span high to low scoring scripts (n = 4). Contingency plans for examiner cancellations are in place at all institutions. Indicators of good performance include evidence-based practice (88%), alignment with departmental outcomes (71%), and meeting examiners’ assessment expectations (50%). CONCLUSION : Clarification of the external examiner’s role is needed in the absence of formal guidelines from governing bodies. CLINICAL IMPLICATIONS : Findings can guide consistent competency standards and also support the Health Professions Council in evaluating physiotherapy training institutions.
Shoulder pain in amateur fast bowlers : a case example illustrating opportunities to embed prevention in undergraduate physiotherapy education
Dawood, Muhammad A.; Olivier, Benitta; Cochrane, Maria Elizabeth (AOSIS, 2026-04-30)
BACKGROUND : Health professions education is undergoing a paradigm shift from a predominantly curative focus towards prevention and health promotion, in line with global health priorities such as Sustainable Development Goal 3 (SDG3). Physiotherapy curricula, however, often still devote limited attention to preventative competencies. OBJECTIVES : The objectives of this study are to identify risk factors for shoulder pain in amateur fast bowlers and illustrate how such evidence can inform the integration of preventative competencies into undergraduate physiotherapy curricula. METHOD : A prospective, longitudinal cohort study was conducted during the 2018–2019 amateur cricket season. Thirty-nine male fast bowlers completed baseline musculoskeletal screening and weekly online questionnaires documenting injury incidence. Physical assessments included shoulder range of motion, scapular control, muscle strength, endurance and stability tests. Data were analysed using t-tests, Mann–Whitney U tests, chi-square and/or Fisher’s exact tests. RESULTS : Nine participants (23%) sustained shoulder pain during the season. Risk factors associated with injury included scapular dyskinesia, decreased internal rotation, increased external rotation, glenohumeral internal rotation deficit, poor endurance and reduced isometric muscle strength. These factors demonstrated moderate-to-large effect sizes. CONCLUSION : The identification of modifiable risk factors for shoulder pain demonstrates the value of embedding screening skills into undergraduate physiotherapy curricula. Teaching students to assess and address risk factors fosters a preventative orientation that extends beyond sports injuries to broader health contexts. CLINICAL IMPLICATIONS : Incorporating risk factor screening into training equips physiotherapy graduates with practical skills for early detection and prevention, thereby reducing the burden of preventable conditions and aligning education with the objectives of SDG3.
Self-perceived competence and readiness of undergraduate physiotherapy students in treating patients with spinal cord injury
Mashola, Mokgadi K.; Bauermeister, Tamsyn; Urio, Clare N.; Michael, Alexandra; Masindi, Rabelani; Mpe, Kgaogelo M.; Dippenaar, Lorraine; Mostert, Karien (AOSIS, 2026-04-30)
BACKGROUND : Physiotherapy management is a necessary core aspect in spinal cord injury (SCI) rehabilitation, and undergraduate preparation for adequate application is imperative. Objectives: To determine physiotherapy students’ self-perceived competence and readiness in treating patients with SCI. METHOD : This study included 48 fourth-year students enrolled in a Bachelor of Physiotherapy degree in South Africa. Students completed a QualtricsXM online survey consisting of 32 questions self-compiled from the Assessment of Physiotherapy Practice (APP) tool and the Dundee Ready Education Environment Measure (DREEM) questionnaire to determine self-perceived competence and readiness to treat SCI patients. Descriptive (frequencies and means) and inferential data (independent t-test and Fisher’s exact test) were analysed using SPSS v26 at a 0.05 level of significance. RESULTS : Students reported 70% self-perceived competence and 73% readiness to treat SCI patients. Theoretical knowledge was perceived as adequate (p < 0.01), and students who completed their SCI clinical block perceived themselves as more competent in treating patients with SCI (p < 0.01). They were able to clinically reason and adequately differentiate between diagnoses (p < 0.01) and safely perform treatment techniques (p < 0.01). CONCLUSION : Students who completed their SCI clinical block had higher self-perception of competence to differentially diagnose SCI and to treat SCI patients safely, compared to those who had not. CLINICAL IMPLICATIONS : Hands-on experience of SCI patient care is encouraged before SCI clinical block rotation. In cases where there are limited clinical placements, universities are recommended to augment written case scenarios with finite supervised patient exposure.
Reaching a consensus on a patellofemoral pain syndrome self-management programme for recreational cyclists in Saudi Arabia : a modified Delphi study
Masoudi, Ameen; Bello, Bashir; Chemane, Nomzamo; Useh, Ushotanefe; Magida, Nontembiso (AOSIS, 2026-02-28)
BACKGROUND : Recreational cycling is increasingly popular in Al Madinah, Saudi Arabia. However, many cyclists lack structured self-management programmes (SMPs) to address patellofemoral pain syndrome (PFPS), a common overuse injury that significantly affects knee function and cycling performance. Despite the growing interest in cycling, a critical gap remains in culturally relevant, evidence-based SMP. OBJECTIVES : Our study aimed to develop expert consensus on the essential components of SMP for recreational cyclists with PFPS. Method: Our study employed a two-round modified Delphi to develop expert consensus on the components of an SMP for recreational cyclists with PFPS. A panel of 25 experts, comprising physiotherapists, biokinetists, sports medicine professionals and exercise physiologists, participated in Round 1, with 19 experts (76% retention) completing Round 2. The process involved rating proposed programme objectives, principles, outcome measures and pain relief strategies using a four-point Likert scale. Consensus was defined as ≥ 70% of respondents selecting either ‘disagree’ to ‘strongly agree’. RESULTS : Consensus was reached on strengthening exercises (88%), evidence-based practice (84%), pain education (84%), PFPS education (92%) and knee pain management (92%). Round 2 results were streamlined and ranked according to pain, function, adherence, cultural resources and engagement supports, following clarifications and the addition of new items from experts. CONCUSION : Our study establishes an evidence-based, region-specific framework for self-managing PFPS among recreational cyclists. CLINICAL IMPLICATIONS : The proposed programme is designed to enhance adherence, reduce the risk of injury and improve cycling performance. Future research should evaluate the effectiveness of this approach, its scalability, outcomes and integration into national sports and rehabilitation strategies.
Experiences of physiotherapists audited by South African medical funding schemes
Meyer, Lesley; Van Staden, Werdie; Mostert, Karien (AOSIS, 2026-02-13)
BACKGROUND : Forensic auditing safeguards patients’ funds by investigating billing irregularities of claims submitted to medical schemes. However, billing irregularity audits can be misguided, as indicated in a study conducted in Australia, Canada and the United States. Negative consequences were reported, including attrition, and patients funding their treatments out of pocket. Medical professionals were penalised, without forensic auditors considering alternative explanations for the alleged irregular billing patterns. Small medical practitioners, unable to defend themselves financially, closed their practices, leaving patients without medical care. In South Africa, the experiences of physiotherapists who underwent forensic audits have not been examined. OBJECTIVES : This study explored physiotherapists’ experiences of forensic auditing by medical scheme administrators. METHOD : An analytical qualitative study was conducted to interview 14 physiotherapists. Three focus group discussions and 11 individual interviews were conducted. A semi-structured open-ended interview guide was used, analysing the data via open and axial coding. RESULTS : The first five themes that emerged captured the adverse experiences of physiotherapists. These were (1) ‘unfairly persecuted, judged and penalised’; (2) ‘overpowered and oppressed’; (3) ‘naively entrapped between a rock and a hard place’; (4) ‘distressed with a knife over your head’ and (5) ‘detrimental and hurtful’. In the sixth theme, ‘seeking remedies pre-emptively and preparedly’, the participants made recommendations to prevent similar unwanted experiences. CONCLUSION : Physiotherapists experienced significant emotional, financial and professional detriment at the hands of South African medical scheme administrators. CLINICAL IMPLICATIONS : The quality of care provided by physiotherapists is adversely affected when forensic audit-related distress occurs.
Effectiveness of mindful breathing exercises on symptom reduction and quality of life in individuals with major depressive disorder : a systematic review
Bin Muaythir, Saad; Mshunqane, Nombeko; Ramano, Enos Morankoana; Bello, Bashir; Magida, Nontembiso (AOSIS, 2026-05-22)
BACKGROUND : Major depressive disorder (MDD) is a global cause of disability, with many patients experiencing suboptimal response to conventional treatments. Mindful breathing exercises, a simple and scalable technique, have emerged as a promising non-pharmacological intervention for alleviating depressive symptoms and improving quality of life. Objectives : To evaluate the effectiveness of mindful breathing exercises on symptom reduction and quality of life in individuals diagnosed with MDD. METHOD : A systematic search of Cochrane Library, MEDLINE (PubMed), PEDro, Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science and BioMed Central databases was conducted from inception to September 2025. Our review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible criteria were intervention studies examining the effects of mindful breathing on depressive symptoms and quality of life in individuals diagnosed with MDD. Two reviewers independently screened the studies, extracted the data and assessed the methodological quality using the Cochrane risk of bias tool. A narrative synthesis was conducted because of heterogeneity in outcome measures and intervention protocols. RESULTS : Two studies involving 179 participants met the inclusion criteria. One study combined cognitive behavioural therapy with breathing exercises, demonstrating improvements in sleep quality, psychiatric symptoms and heart rate variability. Another study demonstrated a significant reduction in anxiety. CONCLUSION : Mindful breathing exercises are beneficial in alleviating symptoms of depression and anxiety, as well as enhancing physiological indicators in people with MDD. CLINICAL IMPLICATIONS : Our review highlights breathing techniques as an affordable, non-pharmaceutical option to conventional treatment; however, more research with rigorous outcomes is needed.
Association between sociodemographic and injury factors in community reintegration following spinal cord injury : an analysis of two datasets
Mothabeng, Joyce Diphale; Eleje, Chiedozie; Nweke, Martins C. (AOSIS, 2026-03-26)
BACKGROUND : Community reintegration after spinal cord injury (SCI) is influenced by personal and injury-related factors. However, data from two South African studies examining these associations have not been jointly analysed. OBJECTIVES : Our study aimed to examine the association between sociodemographic and injury-related factors and community reintegration among people with spinal cord injury (PWSCI). METHOD : Secondary data analysis was conducted using two cross-sectional South African datasets comprising 182 PWSCI. The datasets met the predefined homogeneity criteria and were analysed separately and as a pooled dataset. Community reintegration was measured using the Reintegration to Normal Living Index (RNLI). Descriptive statistics were used to summarise participant characteristics, while Chi-square and Fisher’s exact tests were applied to examine associations between explanatory variables and community reintegration outcomes. RESULTS : In the pooled analysis, better community reintegration was significantly associated with younger age (< 55 years), female sex and employment (p < 0.05). Participants with thoracic and lumbar injuries showed higher levels of reintegration than those with cervical injuries although this association was not statistically significant. Injury severity and aetiology were not significantly associated with community reintegration. CONCLUSION : Younger age, female sex and favourable social circumstances, particularly employment, are associated with better community reintegration among PWSCI. These findings highlight the importance of considering the sociodemographic context and injury characteristics when planning rehabilitation and community-based support interventions. CLINICAL IMPLICATIONS : Early identification of older and unemployed PWSCI may help clinicians target individuals at a higher risk of poor community reintegration and guide tailored rehabilitation strategies.
The reporting of injury epidemiology and risk factors in women's rugby : a scoping review
Bellingan, Lenel; Sewry, Nicola Ann; MacMillan, Candice; Viljoen, Carel (Elsevier, 2026-03)
OBJECTIVES : To map the methodology in currently available scientific literature on injury epidemiology and injury risk factors in women’s rugby union. DESIGN : A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. METHODS : Studies reporting injury epidemiology or injury risk factors in women’s rugby union were included through a search across nine databases. Studies were screened based on the eligibility criteria, and data were extracted and analysed from the studies that were included. RESULTS : Out of 3259 records produced, 55 studies met the inclusion criteria. There was an increase in publications over the last decade, but a lack of studies across Africa and South America. Most studies (n = 17; 31 %) used unique injury definitions, and collected injury data using clinical assessment (n = 26; 47 %). Twenty-five different injury incidence measures were reported, and 33 (60 %) studies reported injury prevalence. Thirty-one (56%) studies investigated risk factors associated with injury in women’s rugby. Sixteen (52 %) studies pooled the data for males and females or rugby fifteens, sevens, and tens. CONCLUSIONS : Current research on women’s rugby injuries highlights several gaps, including limited research across certain countries, pooled data reporting, and univariate risk factor analysis without injured-uninjured player comparisons. Despite existing consensus statements for injury in female sports, studies used varied reporting of injury incidence and prevalence, with most studies using their own study definitions and reporting methods. Future research should follow published guidelines and focus specifically on women’s rugby.
Physiotherapists’ challenges with implementing the policy to screen, identify, assess, and support learners with physical disabilities
Sibuyi, Makwena M.; Mathye, Desmond; Tshabalala, Muziwakhe D.; Mshunqane, Nombeko (AOSIS, 2026-03-03)
BACKGROUND: Challenges persist in implementing the policy to Screen, Identify, Assess, and Support (SIAS) individuals with physical disabilities, particularly in rural provinces of South Africa. The challenges are compounded by the existing imbalance in the distribution of physiotherapists where the majority work in the health sector. However, physiotherapists are well-equipped to assess functional limitations and adapt school environments to support inclusive learning and participation. OBJECTIVES: The study explored the challenges physiotherapists experienced in implementing the policy to SIAS learners with physical disabilities. METHOD: Seven physiotherapists employed by the provincial Department of Education participated in a qualitative, single exploratory case study utilising virtual focus group discussions. Data were analysed with a six-step approach to inductive thematic data analysis on ATLAS.ti version 19 software. RESULTS: Two overarching themes with sub-themes emerged: (1) Poor knowledge of the SIAS policy as a result of lack of in-service training and fear of transfers through the Rationalisation and Redeployment policy; and (2) lack of interprofessional collaboration because of unclear roles and responsibilities, and absence of support structures with regard to the School-Based Support Teams, Circuit-Based Support Teams, and District-Based Support Teams. CONCLUSION: Ongoing in-service training, defining roles and responsibilities of physiotherapists and improving the functioning of support structures are essential for effective policy implementation. CONTRIBUTION: The study bridges the gap in research on the participation of physiotherapists within the SIAS policy framework. Participation of physiotherapists would optimise support for learners and improve educational outcomes.
Epidemiology of ranger injuries among members of the Game Rangers Association of Africa : service-related risk and the call for targeted prevention strategies
Viljoen, Carel Thomas; Van Mechelen, Willem; Sykes, Leanne M.; Clark, James Robert; De Bruin, Louise; Mushonga, Tafadzwa; Janse van Rensburg, Dina Christina (Elsevier, 2026)
OBJECTIVES : To determine the epidemiology of ranger injuries, risk factors for injury, and health support needs among members of the Game Rangers Association of Africa (GRAA). METHODS : We employed a retrospective cross-sectional design to collect data online using a questionnaire developed specifically for this study. We used convenience sampling to include 120 rangers aged 18 years or older who were actively working in Africa. RESULTS : Our findings showed a career injury prevalence of 52 % and period prevalence (past 12 months) of 33 %. The lower limb was the most frequently injured anatomical region (38 %), followed by the upper limb (31 %) and trunk (19 %), specifically affecting the hand (19 %), ankle (14 %), and foot (13 %). The most common injury types included skin lacerations (29 %), followed by muscle injuries (23 %), and fractures (10 %). Working for more than 15 years as a ranger is associated with an increased risk for career injury (OR=2.63) compared to working for 10 years or less. Injuries resulted in a median of 7 days (IQR=0–20 days) lost from work, with most injuries requiring either emergency medical care (31 %) or consultation with a medical doctor (26 %). Rangers need better equipment, cardiovascular fitness training programs, safety training, and mental health support. CONCLUSION : One in every two rangers associated with the GRAA sustains an injury across their careers, with a third of rangers reporting being injured in the past 12 months. Working more than 15 years as a ranger was associated with an increased risk for career injury. Our findings should be used in conjunction with sound clinical reasoning to aid in the development of future injury prevention strategies for rangers working in Africa.
A novel respiratory muscle trainer to enhance pulmonary strength in wheelchair athletes : a pilot randomized controlled study
Subramanian, Thiagarajan; Mani, Suresh; Human, Anri (Termedia Publishing House Ltd., 2025-08-26)
INTRODUCTION : Wheelchair athletes often face challenges related to respiratory function due to the high physical demands of the sport and limitations in core muscle engagement. This study introduces a novel Respiratory Muscle Trainer (RMT) device, designed to enhance endurance and overall performance in this population by strengthening the respiratory muscles, and evaluates its effectiveness for improving sports performance in athletes with wheelchairs. MATERIALS AND METHODS : A pilot randomized controlled trial study was conducted among wheelchair athletes. Twelve participants were divided into an intervention group (n = 6) using the respiratory muscle trainer and a control group (n = 6) performing conventional training, for four weeks. The RMT device provided adjustable resistance for both inspiration and expiration, promoting progressive overload training. The outcomes comprised maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), forced vital capacity (FVC) and forced expiratory volume in first second (FEV1). RESULTS : The intervention group showed significant improvements in MIP (from 62.3 ± 12.4 to 75.6 ± 10.8 cmH2O) and MEP (from 78.5 ± 15.2 to 90.2 ± 12.7 cmH2O) compared to the control group (p < 0.05). Improved pulmonary function was noted, as indicated by FVC and FEV1 (mean differences of 0.2 L and 0.3 L). Functional performance measures such as changes in wheelchair propulsion efficiency and endurance during sport-specific tasks represent functional outcomes related to cardiovascular and muscular performance. CONCLUSIONS : The RMT device effectively improved respiratory muscle strength and functional capacity in wheelchair athletes. Its incorporation into training regimens may enhance performance and respiratory efficiency, contributing to better competitive outcomes.
Lived experiences of male recreational cyclists with patellofemoral pain in Al Madinah, Saudi Arabia
Masoudi, Ameenr; Useh, Ushotanefe; Chemane, Nomzamo Charit; Bello, Bashi; Magida, Nontembiso (MDPI, 2026-02)
BACKGROUND : Patellofemoral pain (PFP) is a prevalent overuse injury among recreational cyclists worldwide. Despite its ubiquity, little is known about the lived experiences of people with PFP, especially in Saudi Arabia, where healthcare and cultural factors may have a specific impact on how the condition is managed. The aim of this study was to explore the lived experiences of recreational cyclists with patellofemoral pain in Al Madinah, Saudi Arabia. METHOD : A qualitative, descriptive design using reflexive thematic analysis was employed. Eleven male recreational cyclists aged 28-44 years diagnosed with PFP were purposely recruited from Al Madinah Physical Therapy Centre. Female participants were excluded due to cultural constraints regarding sports participation. The participants consented to participate in the study and to be audio recorded. Data were collected through semi-structured interviews using an interview guide. The interview data were transcribed verbatim and thematically analysed using Atlas.ti, version 24. RESULTS : The thematic analysis revealed six themes highlighting the multidimensional impact of PFP. The participants described localised mechanical impairment with rapid onset during activity and persistent symptoms lasting up to two weeks. Pain was exacerbated by eccentric loading and cycling-specific stressors, such as uphill riding, leading to significant anxiety and avoidance behaviours. To maintain activity, these cyclists employed adaptive strategies, including bike modifications and self-management. Notably, PFP imposed substantial cultural and social burdens, hindering spiritual practices, specifically Salah (prayer) postures, professional duties, and family caregiving. While the participants demonstrated resourcefulness through a hybrid of physiotherapy and independent research, pharmacological relief was viewed as a transient solution. CONCLUSIONS : Patellofemoral pain imposes significant multidimensional burdens on recreational cyclists in Al Madinah, which are exacerbated by cultural practices. Physiotherapy offers targeted interventions for pain relief, functional restoration, and participation enhancement, necessitating the need for culturally sensitive management programmes. HIGHLIGHTS Public Health Relevance—How does this work relate to a public health issue? • This study explores the lived experiences of male recreational cyclists with patellofemoral pain (PFP), a condition that significantly limits physical activity, a key determinant of health. • Understanding real-world challenges faced by cyclists with PFP provides insights into barriers that hinder sustained physical activity in an active population. Public Health Significance—Why is this work of significance to public health? • The findings reveal that culturally grounded factors influence symptom management, help-seeking behaviour, and exercise participation among cyclists in Saudi Arabia, which is an understudied population. • By capturing patient-centred perspectives, this study contributes essential qualitative evidence that can inform the design of more responsive, context-specific health and rehabilitation strategies. Public Health Implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health? • The insights generated from this study can support physiotherapists and healthcare planners in developing tailored self-management and injury prevention programmes that promote safe and sustained physical activity. • The findings highlight gaps in awareness, early interventions, and access to appropriate physiotherapy care areas that can guide policy, practice, and future community-based health initiatives.
Preseason injury epidemiology and associated injury risk factors among South African junior provincial rugby players : a prospective cohort study
Meyer, Kyle; Garnett, Daniel; Janse van Rensburg, Dina Christina; Fletcher, Lizelle; Viljoen, Carel Thomas (Taylor and Francis, 2026)
BACKGROUND : The preseason period in rugby plays a key role in athlete preparation for the demands of the sport during the in-competition period. Epidemiological data pertaining to rugby have focused mainly on senior elite professional with little evidence available for junior elite professionals, and even less during the preseason period. This may limit the ability of stakeholders in the sport to understand the effects of injury on participants during the preseason period. OBJECTIVE : To determine the epidemiology, clinical characteristics, and associated risk factors for injury among elite male junior provincial rugby players in South Africa during a 14-week preseason period. DESIGN : A prospective cohort study. METHODS : Data collection procedures were in-line with consensus statements in sports and rugby. Prospective injury data related to 53 male participants were collected. Descriptive statistics was used to describe clinical characteristics of injury, cross-tabulations were created to investigate risk factor associations, and logistic regression was used to model the risk factors. RESULTS : The overall injury prevalence was 75.5%. The incidence of match play injuries (149.26/1000 h) were higher than training injuries (23.32/1000 h). Injuries to the lower limb (48.8%) and muscle/tendon injuries (48.2%) were most commonly reported injuries by anatomical region and tissue type during the preseason period. When controlling for age and playing position, baseline injury was associated with a higher risk of sustaining a subsequent injury during preseason. Age, baseline injury, and playing position showed no statistically significant association with injury risk. CONCLUSION : A high number of training and match play injury incidence were recorded for elite male junior provincial rugby players. Baseline injury was associated with a higher risk of sustaining a subsequent injury during preseason when controlling for playing position and age.
Psychological profile of trail runners associated with running-related injuries : a prospective study
Gajardo-Burgos, Rubén E.; Sánchez, Raimund; Besomi, M.; Viljoen, Carel Thomas; Janse van Rensburg, Dina Christina; Bascour-Sandoval, Claudio (Sage, 2026)
BACKGROUND : Trail running has increased in popularity due to the benefits of physical activity in nature. However, trail running has an inherent risk of running-related injuries (RRI). It is known that athletes with certain psychological traits have a greater tendency to suffer injuries; however, this is unknown in trail runners. The main objective of this study was to identify trail runners' psychological profiles and to compare the proportion of RRI across these profiles. HYPOTHESIS : Trail runners with psychological profiles of high stress, precompetitive anxiety, mental fatigue, competitiveness, and poor sleep quality are at increased risk of RRI. STUDY DESIGN : Prospective cohort study. LEVEL OF EVIDENCE : Level 2. METHODS : A Gaussian mixture model cluster analysis was performed on 202 trail runners (55.5% male; aged 38.7 [33.4-46.2] years) with psychological stress, cognitive and somatic anxiety, self-confidence, mental fatigue, sleep quality, and competitiveness measured 4 weeks before participating in a race. The proportion of RRI during the race was recorded and compared across clusters. RESULTS : Overall RRI proportion during competition was 11.3% (n = 24). The most common RRI were muscle (41.7%) and tendon/bursa (16.7%) injuries, affecting primarily the knee (33.3%) and lower leg (20.8%). Five psychological profiles were identified. Cluster 1 (competitive runners with moderate psychological stress and mental fatigue, low sleep quality and anxiety, and high self-confidence) had a higher RRI proportion than Cluster 3 (similar traits but lower psychological stress, mental fatigue, and higher self-confidence; 21.2% vs 3.2%; P = 0.02). CONCLUSION : Certain psychological profiles in trail runners were associated with higher RRI risk. CLINICAL RELEVANCE : The medical team or trail running coaches should monitor runners with psychological profiles with higher psychological stress, mental fatigue, and cognitive anxiety, as well as lower self-confidence and sleep quality, to design strategies to reduce their risk of RRI.
Pedal power : female cyclists at 94.7 Ride Joburg face fewer illnesses but more injuries and finishing challenges
Janse van Rensburg, Dina Christina; Swart, Xan; Ramagole, Dimakatso Althea; Du Toit, Francois Christiaan; Viljoen, Carel Thomas; Botha, Tanita; Phalane, Mahlane; Beeton, Ramona; Jansen van Rensburg, Audrey (Edizioni Minerva Medica, 2026-02)
BACKGROUND: Mass participation in amateur cycling events is popular, and ensuring participant safety is crucial. This study aimed to determine the epidemiology of medical encounters (MEs), including injury and illness, at mass-participation amateur cycling events and to explore associated risk factors. METHODS: We conducted a cross-sectional, descriptive, exploratory analysis of operational data collected during the 2015-2016 94.7 Ride Joburg cycling race. Outcomes include frequency (N., %), prevalence (%), incidence (injuries/1000 participants), did-not-finish (DNF, %), and Odds Ratio (OR, 95%CI). RESULTS: In total, 44849 individuals, mean age 40.06±11.68, participated in the 94.7 Ride Joburg cycling race during 2015-2016. We report the prevalence for MEs (5.3%) (injury: 1.7%, illness: 3.6%). The incidence of all MEs was 52.71 (50.61-54.88) (injury: 16.79 [15.61-18.03], illness: 35.92 [34.19-37.72]). Most race participants were male (79.0%), aged 31-50 (58.9%). Older age decreased the odds of injury, illness, or not finishing (P<0.001). Females had higher odds of injury (OR:1.43; 1.21-1.67; P<0.001) and for DNF (OR:1.57; 1.46-1.70; P<0.001) but lower odds of illness (OR:0.73; 0.64-0.64; P<0.001), compared to males. Overall, 7.9% of participants DNF, 6.9% had MEs, 3.2% were injured, and 3.8% were ill. Medical point location and distance were not significantly associated with medical encounters. CONCLUSIONS: Older participants have lower odds of injury and illness encounters. Females have higher odds of injury encounters and not finishing the race but lower odds of illness encounters than males. These findings offer insights into injury and illness at mass-participation amateur cycling events.
Independent risk factors associated with a history of exercise associated muscle cramps (EAMC) among 21460 cycling race entrants (SAFER XXXVI) : a descriptive cross-sectional study
Pohl, Carey; Schwellnus, Martin Peter; Sewry, Nicola Ann; Boer, Pieter; Jordaan, Esme; Viljoen, Carel Thomas (Elsevier, 2026-03)
BACKGROUND : There is limited research on cyclists with a history of exercise associated muscle cramps (hEAMC) defined as muscle cramping (painful, spontaneous, sustained spasm of a muscle) during or after cycling. OBJECTIVE : To determine the epidemiology, clinical characteristics, and risk factors associated with hEAMC in cyclists taking part in a mass participation cycling event. METHODS : 21,460 race entrants from the 2016 Cape Town Cycle Tour completed an online questionnaire, which is based on the guidelines for recreational exercise participation from the European Association of Cardiovascular Prevention and Rehabilitation [EACPR]. The main outcome measures were: the lifetime prevalence hEAMC (%; 95% confidence intervals), independent risk factors (adjusted for age and sex) associated with hEAMC (history of chronic disease, history of allergies, history of chronic medication use, history of medication use before and during race, history of cycling injuries, and cycling training/racing variables). Poisson regression was used to calculate the prevalence (%) of the variables of interest, with 95% confidence intervals. RESULTS : The retrospective lifetime prevalence of hEAMC was 30.51%. EAMC in cyclists affects mainly the quadriceps muscles and occurs in the 4th quarter during a race. Novel independent risk factors associated with an increased risk of hEAMC in cyclists were: increased number of years participating as a recreational cyclist (PR=1.03 per 5 years increase; p<0.0001), a higher chronic disease composite score (PR=1.36 times increased risk for every 2 additional chronic diseases; p<0.0001), a history of any allergies (PR=1.18; p<0.0001), medication use before or during event (PR=1.41; p<0.0001) a history of an acute (PR=1.30; p<0.0001) and gradual onset injury (PR=1.29; p<0.0001). CONCLUSION : Our study identified novel independent risk factors associated with a hEAMC. These results, in combination with other known risk factors, could assist future targeted prevention programmes and the management of EAMC in recreational cyclists. HIGHLIGHTS • Older cyclists and males have a significantly higher lifetime prevalence of hEAMC. • EAMC in cyclists affects mainly the quadriceps muscles. • EAMC in cyclists occurs mainly in the 4th quarter during a race. • Risk factors for hEAMC: experience, chronic disease, allergies, medications, past injury.
Illness is common in trail runners during training : a prospective cohort study
Janse van Rensburg, Dina Christina; Jansen van Rensburg; Audrey; Boer, Pieter Henk; Serero, Precious; Botha, Tanita; Schoeman, Marlene; Viljoen, Carel Thomas (Elsevier, 2026-05)
OBJECTIVES : Trail runners often experience illness during event preparation. We aimed to prospectively determine prevalence, incidence, clinical characteristics, severity (time-loss, burden) and associated illness risk factors amongst South African male and female recreational trail runners of different ages over a 30-week training period. DESIGN : Prospective cohort. METHODS : Illness and training data from 152 trail runners (120 males, 32 females) were collected every 14 days over 30 weeks using the updated OSTRC-H questionnaire. Illness prevalence (%), incidence (I: per 1000 trail running exposure-days), incidence ratio (IR), severity [% time-loss; illness burden (IB: days lost/1000 trail running exposure-days)], and associated risk factors are reported. RESULTS : Over 30 weeks, 52 % of runners reported illness, with a mean two-week all-illness prevalence of 10.1 %. The overall illness incidence was 7.2 (95 % CI: 5.7–9.2). The winter-to-summer IR was 1.6 (p = 0.022). Illness incidence in females (I = 9.7) was higher than in males (I = 6.6), with a female:male IR of 1.5 (p < 0.05). Most illnesses affected the respiratory (64.3 %), digestive (15.9 %) and musculoskeletal (5.7 %) systems. Moderate illness severity (8–28 days time-loss) occurred in 29.3 % of runners. The overall IB was 43.2 days lost. BMI ≥ 25 kg/m2 was associated with illness, but no significant illness risk factors were identified via Poisson regression. CONCLUSIONS : During a 30-week training period, 52 % of runners reported illness, with a higher incidence in females. The respiratory tract accounted for > 60 % of illnesses. One in three trail runners experienced > one week time-loss. A higher BMI > 25 kg/m2 was associated with illness. Further research is needed to identify risk factors and develop prevention strategies. PRACTICAL IMPLICATIONS • Prioritise respiratory health monitoring • Screen for high-risk profiles early • Tailor strategies for females and higher-BMI runners • Inform trail running guidelines HIGHLIGHTS • Trail runners show an illness prevalence of 10.1% during training. • Females experience significantly higher illness incidence than males. • Illness mainly affects the respiratory system of trail runners during training. • Approximately one-third of trail runners suffer from moderate to severe illness, resulting in > 8 days of time-loss in a 30-week training period. • Trail runners with a higher BMI (> 25 kg/m2) are more susceptible to illness.
Are endurance runners at higher risk of depression? Screening for depression and risk factors
Scheer, Volker; Valero, David; Thuany, Mabliny; Knechtle, Beat; Viljoen, Carel Thomas; Escolano, Esther Ruescas; Burgos, Encarna Valero (Thieme Gruppe, 2025-01-20)
Depression is an important public health issue. In the general adult population, about 6.7% are affected. Little data are available about endurance runners. We conducted a prospective survey study screening for depression using the Patient Health Questionnaire and investigating potential associated risk factors in endurance runners (≥ 21.1-42.2 km) and ultraendurance runners (≥ 42.2 km). Statistical analysis included descriptive statistics, predictive techniques, and regression analysis. A total of n = 601 runners participated (female n=222 and male n=379; mean age [SD]: 42.8 years [± 10.1]). Overall, 11.3% screened positive for major depression, particularly female runners compared to male runners (p=0.002) and endurance runners compared to ultraendurance runners (p=0.023). No significant differences were observed among performance levels (elite vs. nonelite). Mild depression was observed in 21.6% of runners. Factors associated with a higher risk for screening for major depression included age (p<0.001), particularly runners under the age of 28 years, previous self-reported history of depression (p<0.001), more frequent weekly workouts (4-5/wk; p=0.021), weeks lost to injury (p=0.022), and female sex (p=0.025). A third of endurance and ultraendurance runners screened positive for depression, highlighting the importance of creating awareness for mental health issues and potential screening for athletes and providing access to appropriate support services and education.

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