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The Physician and Sportsmedicine
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/ipsm20
Epidemiology of injuries in track and field athletes:
a cross-sectional study of specific injuries based
on time loss and reduction in sporting level
Christophe Lambert , Noémie Reinert , Linda Stahl , Thomas Pfeiffer , Bernd
Wolfarth , Daniel Lachmann , Sven Shafizadeh & Ramona Ritzmann
To cite this article: Christophe Lambert , Noémie Reinert , Linda Stahl , Thomas Pfeiffer , Bernd
Wolfarth , Daniel Lachmann , Sven Shafizadeh & Ramona Ritzmann (2020): Epidemiology
of injuries in track and field athletes: a cross-sectional study of specific injuries based
on time loss and reduction in sporting level, The Physician and Sportsmedicine, DOI:
10.1080/00913847.2020.1858701
To link to this article: https://doi.org/10.1080/00913847.2020.1858701
Published online: 08 Dec 2020.
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ORIGINAL RESEARCH
Epidemiology of injuries in track and field athletes: a cross-sectional study of
specific injuries based on time loss and reduction in sporting level
Christophe Lambert
a,b,c
, Noémie Reinert
d
, Linda Stahl
e
, Thomas Pfeiffer
a
, Bernd Wolfarth
f
, Daniel Lachmann
g
,
Sven Shafizadeh
e
and Ramona Ritzmann
b
a
Department of Experimental Sports Traumatology, University of Witten/Herdecke, Cologne Merheim Medical Centre, Cologne, Germany;
b
Department of Biomechanics and Performance Diagnostics, Praxisklinik Rennbahn AG, Muttenz, Switzerland;
c
Department of Trauma and
Orthopaedic Surgery, University of Witten/Herdecke, Cologne Merheim Medical Centre, Cologne, Germany;
d
Department of Orthopaedics and
Traumatology, University Hospital Basel, Basel, Switzerland;
e
Department of Trauma Surgery and Sports Traumatology, Sana Dreifaltigkeits-
Krankenhaus Cologne, Cologne, Germany;
f
Department of Sports Sciences, Division of Sports Medicine, Humboldt University of Berlin, Berlin,
Germany;
g
Vice-Rectorate for Teaching and Studies Central Evaluation of Studies and Teaching, University of Cologne, Cologne, Germany
ABSTRACT
Objectives: To prevent the occurrence of injury in a sport, exact knowledge of injury patterns is
needed. To synthesize sport-specific injuries in track and field comparing elite and recreational level
athletes, as well as gender. Furthermore, analyze the time loss due to injury and reduction in athletic
performance.
Methods: Injury type-specific frequencies were recorded according to discipline, gender and perfor-
mance level. Injury severity was assessed by time loss duration and performance reduction.
Results: 64% of athletes suffered at least one injury. In the top 10 ranking, 83% (n = 524) were located
in the lower extremities. A muscle strain of the thigh had the highest prevalence in sprint (34%, n = 41),
jump (15%, n = 15) and middle-distance running (16%, n = 6). More injuries occurred during training
(75%, n = 165) as compared to competition (25%, n = 56). The longest time loss was documented in
throwing with a downtime of 36 weeks after a ligament injury of the elbow and 39 weeks after a muscle
injury of the elbow. The injury with the highest number of athletes with a reduced level of performance
was the foot ligament injury in sprint athletes at 100%.
Conclusion: Assessing time loss and performance reduction in athletics, there are discipline-specific
injury patterns. This study points out the high prevalence of training injuries, highlighting the need for
future investigations to adapt training management, improve medical care and rehabilitation with
respect to every discipline.
ARTICLE HISTORY
Received 15 October 2020
Accepted 24 November
2020
KEYWORDS
Track and field; injuries;
return to competition;
Olympic games; athletes
Introduction
Track and field cause various injury types with an existing
challenge in the recognition, treatment and prevention of
these injuries[1]. Track and field disciplines are clustered into
four main categories: 1) sprints, middle- and long-distance
running, relays, hurdling and steeple chase as track events; 2)
pole vault and jumps (long, triple and high), shot put and
throwing (javelin, discus and hammer) as field events; 3) road
events; and 4) combined events, such as the decathlon for
men and heptathlon for women (Official Olympic Games web-
site 2020). Considering the technical attributes and physiolo-
gical prerequisites, loads and strain to body regions are
discipline-specific. Likewise, training intensity and load differ
among disciplines [2,3]. Runners experience impact forces
equivalent to 5 times the body weight to the foot which can
lead to overuse injuries (such as stress fractures) [4]. In con-
trast, sprint and jump activities are more prone to acute
injuries due to supramaximal forces coupled with high strain
rates eccentrically loaded on the pre-contracted musculature
within the stretch-shortening cycle [5]. Beside this, Caine et al.
manifest that high jump and pole vault athletes are more
likely to sustain traumatic injuries, whereas throwing disci-
plines are more likely to encounter overuse or acute injuries
to the upper body [6].
A priori, injuries to the lower extremity are the most com-
mon in athletic sports disregarding gender [3,7,8]. However,
there are existing differences in injury patterns and frequen-
cies among the disciplines for men and women[1]. The injury
rates in athletics range from 1 to 30 per 1000 athletic expo-
sures (AE) [6], with an injury incidence of 68% in elite athletes
[3]. A mismatch in injury surveillance in athletic sports led
contradiction with regard to injury circumstances differen-
tiated by training vs. competition [9]. Underestimation due
to large proportions of underreported injuries in training
may have biased numerical data and current overviews.
Injury severity is associated with the duration of sporting
time loss, defined by an injury ‘that leads to the athlete being
unable to take part in athletic training and/or competition
after the incident occurred’ [9]. Consequences entail a loss of
performance up to the end of a professional career [10].
CONTACT Christophe Lambert christophe.lambert@web.de Department of Trauma and Orthopaedic Surgery, University of Witten/Herdecke, Cologne
Merheim Medical Centre, Cologne 50931, Germany
THE PHYSICIAN AND SPORTSMEDICINE
https://doi.org/10.1080/00913847.2020.1858701
© 2020 Informa UK Limited, trading as Taylor & Francis Group
Statistical causality has been manifested between injury inci-
dence and the level of performance in athletes for competitive
events [7]. However, the literature presents contradictory
information. The same applies to gender differences regarding
injury frequencies and mechanisms, which are a constant mat-
ter of debate with inconclusive data reported [11].
The aim of this study is to synthesize sport-specific injuries
differentiated by athletic disciplines comparing both elite and
recreational level athletes, as well as gender, at the moment of
the injury differentiated by training and competition.
Furthermore, the time loss in competition and reduction in
athletic performance after an injury will be analyzed. The
results could provide a solid foundation for further research
and implementation of sport-specific injury prevention
programs.
Material and methods
Study design
A survey was designed to retrospectively analyze the self-
reported injury prevalence in one Olympic cycle from the
Summer Olympic Games in London in 2012 to Rio de Janeiro
in 2016. The occurrence of injury was documented with
respect to the affected body region and damaged structure.
Data collection
Injury characteristics were assessed by a three section, 139-
item questionnaire [12]. The German Olympic Federation and
associated international sports federations published the sur-
vey and sent it via e-mail, encouraging athletes to participate.
Section one contained questions on the competitive level of
athletes classified into five performance classes: international
elite, international, national, regional or recreational, marking
the highest level at which athletes had competed in their
career [12].
Section two contained questions about the athletes’ inju-
ries. The athletes were asked to report only injuries referring to
a major injury that resulted in a time loss of > 3 weeks [13]. In
cases of positive answers an athlete specified the affected
anatomical region, the injury type and damaged structure
(Table 1). For each injury, the duration of time loss (weeks),
the level of performance following the return to sport (same
vs. reduced) and the age when the injury occurred were
assessed [12].
Section three collected data on anthropometry, age when
completing the survey and gender.
Study population
A total of 743 individuals participated in the survey. The
exclusion criterion was an incomplete questionnaire. Athletes
classified as competing as international or national elite were
pooled into the ‘competitive sports’ category. Athletes classi-
fied as competing in recreational sports were grouped into the
‘recreational sports’ category. With reference to the Olympic
Studies Center [14], the individuals were synthesized into
seven different track and field disciplines: sprint, jump, throw-
ing/putting, decathlon/heptathlon, long-distance running, and
middle-distance running.
Statistical analysis
We used SPSS 25.0 (SPSS, Inc, Chicago, Illinois, USA) for the
statistical analyses encompassing descriptive statistics and sig-
nificance tests. To compare injury prevalence throughout the
Olympic cycle (2012–2016), we used χ2 tests. To analyze the
top eight injury diagnoses and the discipline-specific top three
diagnoses, between disciplines, gender, competitive or recrea-
tional athletes, and whether they occurred during training or
competition, as well as the performance after the injury, we
calculated χ2 tests. Since the duration of sporting time loss in
weeks is a non-normal, interval scales variable, we computed
Mann-Whitney-U tests (gender and competitive level) or
Kruskal-Wallis tests for a comparison of the duration of sport-
ing time loss between the top eight diagnoses.
We considered p-values < 0.05 to be statistically significant.
Only specific injuries with more than three events were
Table 1. Flow chart diagram of the included athletes separated by injury topography and track and field disciplines with reference to the number of injuries with
a time loss of > 3 weeks.
Spalte1 Spalte2 Spalte3 Spalte4 Spalte5 Spalte6 Spalte7
743 athletes participated
743 athletes Completed the survey
Sprint 121
athletes
Jump 81
athletes
Throwing and
Putting103 athletes
Decathlon and
Heptathlon62 athletes
Running long distance
303 athletes
Running middle distance
61 athletes
Topography Injuries in the different disciplines clustered by regional topography
Lower extremity
(except knee)
96 injuries
(79%)
72 injuries
(71%)
26 injuries (28%) 40 injuries (55%) 132 injuries (69%) 29 injuries (78%)
Knee 17 injuries
(19%)
6 injuries
(6%)
20 injuries (21%) 20 injuries (27%) 49 injuries (26%) 6 injuries (16%)
Upper extremity
(except knee)
0 injuries
(0%)
5 injuries
(5%)
17 injuries (18%) 5 injuries (7%) 0 injuries (0%) 0 injuries (0%)
Shoulder 1 injuries
(1%)
3 injuries
(3%)
9 injuries (10%) 2 injuries (3%) 1 injuries (1%) 0 injuries (0%)
Front torso 0 injuries
(0%)
0 injuries
(0%)
1 injuries (1%) 6 injuries (8%) 0 injuries (0%) 0 injuries (0%)
Back 6 injuries
(5%)
14 injuries
(14%)
19 injuries (20%) 0 injuries (0%) 9 injuries (5%) 2 injuries (5%)
Head 0 injuries
(0%)
1 injuries
(1%)
2 injuries (2%) 0 injuries (0%) 0 injuries (0%) 0 injuries (0%)
2C. LAMBERT ET AL.
analyzed with regard to time loss in sport and reduction of
sporting performance. Therefore, race walking was not
included in the data analysis.
Ethics approval has been received by the Ethical committee
of the University of Witten/Herdecke. At the beginning of the
questionnaire the athletes were informed about the anon-
ymous use of the data for scientific purposes and asked to
confirm their consent. Only Athletes who confirmed their
consent where included in the study.
The authors used the ‘Declaration of Helsinki ethical prin-
ciples for medical research involving human subjects’ as
standards.
Results
During the study period, 475 (64%) athletes suffered at least
one injury. A total of 628 injuries were documented. With
reference to the numerical total, 326 injuries (52%) coded
the top 10 in located exclusively in the lower extremities.
Injury prevalence in one Olympic cycle
After the 2012 Olympic Games in London, the injury preva-
lence decreased slightly, with a subsequent progressive rise
from 14% to 30%, reaching its peak in the year of the Olympic
Games in Rio (χ2 = 116.305; df = 4; p < 0.001).
Top 10 ranking of injuries
All top 10 ranked injuries occurred in the anatomical region of
the lower limb (Figure 1). In all, 83% (n = 524) of all injuries
occurred in the lower extremities with affected structures
encompassing the contractile material, cartilage, ligaments
and bone. Muscle strain of the thigh was the injury with the
highest prevalence in athletic sports, with an occurrence of
13% (n = 83), followed by foot ligament injuries (8%, n = 49)
and ankle ligament injuries (7%, n = 46). Unspecific knee
injuries (6%, n = 40), foot fractures (5%, n = 35), knee cartilage
injuries (4%, n = 25), muscle injuries of the fibula (4%, n = 25),
knee meniscus injuries (4%, n = 23), foot muscle (3%, n = 19)
and capsule injuries (2%, n = 13) complemented the top
rankings of documented injuries.
Top three ranking of injuries differentiated by disciplines
Prevalence and numerical totals are described in Table 2.
Among all disciplines, there exists a large variation of two
dozen different injuries related to a specific topography. The
majority of the injuries occurred in the lower limb (92%,
n = 204). Only two injuries occurred in the upper extremity
(8%, n = 17), exclusively in the disciplines of throwing/putting.
Muscle strain of the thigh was the injury with the highest
prevalence in sprint (34%, n = 41), jump (15%, n = 15) and
middle-distance running (16%, n = 6) disciplines.
Topographically, the foot and ankle were highly represented.
Foot ligament injuries occurred in sprint (7%, n = 9), long-
distance running (10%, n = 19) and decathlon/heptathlon (8%,
n = 6) athletes and foot fractures in jump (10%, n = 10) and
middle-distance running (11%, n = 4) athletes. Upper ankle
ligament injuries occurred in sprint (6%, n = 7), jump (8%,
n = 8), throwing/putting (9%, n = 8) and decathlon/heptathlon
(12%, n = 9) disciplines. (Figure 2)
Top three injuries during training and competition
Comparing the injury prevalence (Figure 3), more injuries
occurred during training (75%, n = 165) as compared to
competition (25%, n = 56). This is valid for all injuries located
in all body regions recognized in our survey, despite thigh
muscle injury in sprint (training = 42%, competition = 58%).
Duration of sporting time loss
The majority of injuries (60%) caused a time loss of < 3 months.
Four injuries had a time loss of > 20 weeks. In sprint, foot
ligament injuries resulted in a time loss of 23 weeks, and
0
2
4
6
8
10
12
14
Injuries in %
Figure 1. Top 10 injuries sorted by prevalence in track and field.
THE PHYSICIAN AND SPORTSMEDICINE 3
cartilage injuries of the knee resulted in a time loss of
29 weeks. Longest time losses were documented in throwing
after a ligament injury of the elbow (36 weeks) and a muscle
injury of the elbow (39 weeks). The longest time loss in long-
distance running was caused by an unspecific injury of the
knee (14 weeks), in middle-distance running by a fracture of
the tibia (12 weeks), in decathlon/heptathlon by thigh muscle
injuries (13 weeks) and in jump by upper joint ligament injury
(16 weeks) (Figure 4(a)).
Reduction of performance
Individuals with a performance reduction ranged from 14% to
100%, with a significant dependency on discipline, anatomical
location and affected body structure (Figure 4(b)). Foot liga-
ment injuries in sprint caused the highest performance reduc-
tion (100%). In long-distance running, 50% of the athletes with
an unspecific injury of the knee reported a reduced level of
competition after the injury. In middle-distance running, 40%
of athletes with a tibia fracture; in throwing, 43% of athletes
after a muscle injury of the elbow and unspecific knee injury;
in decathlon/heptathlon, 37% of the athletes with a foot liga-
ment injury; and in jump, 67% of the athletes with an upper
ankle ligament injury reported a reduced level of performance.
Gender
Male long-distance runners had more foot ligament injuries
((χ2 = 4,546; df = 1; p < 0.05) and muscle injuries of the fibula
(χ2 = 7,702; df = 1; p < 0.01) compared to female athletes. In
decathlon/heptathlon, male athletes suffered foot ligament
injuries more often than their female counterparts
(χ2 = 4,381; df = 1; p < 0.05). There were no significant
differences with reference to gender regarding injuries in
training and competition, duration of time loss and perfor-
mance reduction comparing the different disciplines.
Level of competition
The injury prevalence of competitive athletes (44%) was sig-
nificantly higher (χ2 = 18.35; df = 1; p < 0.001) as compared to
recreational athletes (34%). Recreational athletes had more
foot ligament injuries than competitive level athletes
(χ2 = 5,474; df = 1; p < 0.05). Contrarily, competitive athletes
had more unspecified knee injuries (χ2 = 5,768; df = 1;
p < 0.05) and foot fractures (χ2 = 7,028; df = 1; p < 0.01).
There were no significant differences with regard to injuries in
training and competition, duration of time loss and reduction
of sporting performance.
Discussion
This study provides an important insight into injury preva-
lence distinguished by discipline, injury-associated regional-
ity, structure and severity. Based on epidemiological data
collected during an entire Olympic cycle, we derived four
main findings: 1) subgroup-specific injuries existed with
a majority of injuries in the lower extremity; 2) more injuries
occurred during training as compared to competition; 3)
thigh muscle injuries were the most common; however,
foot ligament injuries caused the highest performance
drop in sprint and the longest time loss injuries were seen
in throwing sports; and 4) among all disciplines, injuries in
the upper extremities, thorax or head were
underrepresented.
Injury prevalence in one Olympic cycle
A progressive rise in injury occurrence over the four years
preparation period peaked in the year of the Olympic
Games. This increase in pre-participation injury occurrence
may arise from an increase in training intensity, leading to
a higher risk for in-competition injuries [15]. Alonso et al.
found that about one-third of the athletes sustained an injury
in the month preceding Moscow 2013 IAAF Championships
Table 2. Top three injuries sorted by prevalence in track and field disciplines.
Top 3 N (Injuries) % (of all reported injuries) Injuries/Year/Injuries Injuries/Olympiad/Athlete
Sprint 1) Thigh muscle injury 41 33,6 0,067 0.068
2) Foot ligament injury 9 7,4 0,015 0.015
3) Upper ankle ligament injury 7 5,7 0,011 0.012
3) Knee cartilage injury 7 5,7 0,011 0.012
Jump 1) Thigh muscle injury 15 14,9 0,03 0.037
2) Foot fracture 10 9,9 0,02 0.025
3) Upper ankle ligament injury 8 7,9 0,016 0.02
Throwing/Putting 1) Ellbow ligament injury 10 10,6 0,021 0.019
2) Upper ankle ligament injury 8 8,5 0,017 0,016
3) Ellbow muscle injury 7 7,4 0,015 0,014
3) Knee meniscus injury 7 7,4 0,015 0,014
Decathlon/Heptathlon 1) Upper ankle ligament injury 9 12,3 0,025 0,029
2) Thigh muscle injury 7 9,6 0,019 0,023
3) Foot ligament injury 6 8,2 0,016 0,019
Long-distance running 1) Foot ligament injury 19 9,9 0,02 0,013
2) Knee unspecified injury 18 9,4 0,019 0,012
3) Fibula muscle injury 13 6,8 0,014 0,009
Middle-distance running 1) Thigh muscle injury 6 16,2 0,032 0,02
2) Tibia fracture 5 13,5 0,027 0,016
2) Knee unspecified injury 5 13,5 0,022 0,013
3) Foot fracture 4 10,8 0,022 0,013
4C. LAMBERT ET AL.
with a 2–4 times higher injury during competition [16]. Poor
management of load and fatigue are major risk factors in
athletes trying to push their performance to physical and
psychological limits to reach their competitive goals [17].
Our findings are underlined by Harringe et al., who documen-
ted competing elite athletes disrespecting full recovery
despite an acute injury due to group pressure [18]. These
observations are not reported in recreational athletes and
could account for a higher injury rate in competitive level
athletes.
Top ten ranking of injuries
The most affected anatomical region was the lower extremity
(incidence of 83%) [3,19]. The muscle tight injury is the most
frequent injury. Hamstring injuries often occur from sprinting
and eccentric activities and do have a particular impact on
downtime depending on their size and location in the muscle-
tendon complex [20]. Moreover, the use of spikes and initial
toe contact are considered as risk factors for knee flexor
injuries in sprinters [21]. Thereby, gender differences were
b
Figure 2. Illustration of the human body parts distinguished by joints, segments and regions (bolt letters) and the survey-based structures with its injury specified
(italic letter). The red shadow highlights the most affected segments and joints, which are exclusively located in the lower extremity.
THE PHYSICIAN AND SPORTSMEDICINE 5
20
40
60
80
Injury in a training session
Injury in competition
100
Sprint
20
40
60
80
100
Jump
20
40
60
80
100
Throwing/Putting
20
40
60
80
100
gninnurecnatsid-elddiM
20
40
60
80
100
gninnurecnatsid-gnoL
20
40
60
80
100
Decathlon/Heptathlon
Thigh
muscle
injury
Knee
cartilage
injury
Upper ankle
ligament
injury
Foot
ligament
injury
Thigh
muscle
injury
Thigh
muscle
injury
Foot
ligament
injury
Elbow
ligament
injury
Upper ankle
ligament
injury
Foot
fracture
Knee
unspecifed
injury
Tibia
fracture
Upper ankle
ligament
injury
Foot
fracture
Fibula
muscle
injury
Knee
unspecified
injury
Knee
meniscus
injury
Elbow
muscle
injury
Upper ankle
ligament
injury
Foot
ligament
injury
Thigh
muscle
injury
Figure 3. Injury prevalence regarding training and competition distinguished by the associated disciplines. Percental majorities of injuries have been experienced in
the training sessions as compared to competitions.
6C. LAMBERT ET AL.
0
10
20
30
40
50
60
70
80
90
100
1) Thigh muscle injury
2) Foot ligamennjury
3) Upper ankle ligamennjury
3) Knee carlage injury
1) Thigh muscle injury
2) Fooracture
3) Upper ankle ligamennjury
1) Ellbow ligamennjury
2) Upper ankle ligamennjury
3) Ellbow muscle injury
3) Knee meniscus injury
1) Upper ankle ligamennjury
2) Thigh muscle injury
3) Foot ligamennjury
1) Foot ligamennjury
2) Knee unspecified injury
3) Fibula muscle injury
1) Thigh muscle injury
2) Tibia fracture
2) Knee unspecified injury
3) Fooracture
Sprint Jump Throwing/Pung Decathlon/Heptathlon Long-distance
running
Long-distance
running
Long-distance
runningL
Dura on o!ime loss athletes need to return to
sports (weeks)
Middle-distance
running
0
10
20
30
40
50
60
70
80
90
100
1) Thigh muscle injury
2) Foot ligamennjury
3) Upper ankle ligamennjury
3) Knee carlage injury
1) Thigh muscle injury
2) Fooracture
3) Upper ankle ligamennjury
1) Ellbow ligamennjury
2) Upper ankle ligamennjury
3) Ellbow muscle injury
3) Knee meniscus injury
1) Upper ankle ligamennjury
2) Thigh muscle injury
3) Foot ligamennjury
1) Foot ligamennjury
2) Knee unspecified injury
3) Fibula muscle injury
1) Thigh muscle injury
2) Tibia fracture
2) Knee unspecified injury
3) Fooracture
Sprint Jump Throwing/Pung Decathlon/Heptathlon
Atheltes with a persistently reduced
level of perfomance (%)
Long-distance
running
Middle-distance
running
Figure 4. Graphs illustrate (a) downtime after injury in the different disciplines and (b) percental rates of athletes that experienced a significant and persistent loss of
performance after the injury. Note that the order of the injuries as indicated on the abscissa refers to the top three injuries with the highest prevalence ordered from
left to right.
THE PHYSICIAN AND SPORTSMEDICINE 7
neglectable. The only differences with significantly higher
rates for the male subpopulation existed in the decathlon
and long-distance running for foot ligament injuries and mus-
cle injuries in the shank.
Top three ranking of injuries differentiated by track and
field disciplines
Injury characteristics are considered to differ between dis-
ciplines with a predominance of injuries in the lower extre-
mity [1]. Injuries to the lower limb and foot (knee excluded)
account for about 64% of athletes in running sports (short-,
middle-, and long-distance). With an emphasis on injuries to
the upper extremity, about 60% occurred in throwing sports.
Throwing forces manifest > 1000 N tolerated by the rotator
cuff and deltoid muscle [22]. Thereby, energy is transferred
through the kinetic chain from the lower to the upper
extremity causing exceedingly high forces with a relatively
high prevalence of ankle injuries in throwing sports [23]. In
elite track and field athletes, Malliarapoulos et al. found
a significantly higher frequency of hamstring injuries result-
ing from a previous ankle injury. Both injuries causing high
downtime rates and performance reductions [24]. Despite
the diversity within damaged regions and affected struc-
tures, the interconnection of these injuries with a particular
high prevalence indicates a significant predisposition in
regard to the individualized injury history. Furthermore, it
is noteworthy to mention that this study revealed a high
number of injuries to the elbow joint. In overhead throwing
activities, mainly during the late cocking and early accelera-
tion movements, the elbow experiences high valgus forces
leading to microtrauma to the ulnar collateral ligament
(UCL), muscles and the joint itself [25].
Top three injuries in different track and field disciplines
during training and competition
One main finding of this study is the significantly higher
number of injuries sustained during training as compared
to competition. This opposes the major opinion in current
literature as scientific evidence is still contradictory [2,3,26],
and manifested discrepancies may originate from the differ-
ing surveys and survey periods. A large amount of prospec-
tive and retrospective data was collected by assessing
injuries during competitive events, which means from the
time of arrival until the end of a competition. In competitive
periods, intensive training sessions are avoided. The study of
Feddermann et al., for instance, summarized the data of 13
international championships referring to an injury preva-
lence of 70% in competition referring to the training time
relation: athletes spend less time training during champion-
ships than during the regular season [27]. This perspective is
supported by other authors [8,28] and leads to major limita-
tions with reference to a conclusive statement. However, we
noted a higher number of thigh muscle injuries for sprinting
athletes in competition as compared to training, as these are
mostly acute sprains as a result of submaximal muscular
power and acute overload in competitive events [5].
Duration of sporting time loss
The type and severity of an injury have a direct impact on the
return-to-sports (RTS) time frame [29]. On the international
level, training time loss due to an injury is considered
a major determinant for success or failure [30]. The current
results show that the duration of sporting time loss differed
between the injuries with the longest downtime for ligament
and muscle injuries of the elbow (36 week and 39 weeks,
respectively) in throwing sports. Injuries to the ligaments and
tendons have a high impact on a thrower’s career, and in 40%
of athletes, time loss rates of more than 28 days are common
[31]. With 29 weeks of downtime, sprinting athletes showed
the crucial role of injuries to the cartilage of the knee, which
are common in the athletic population with a clinical outcome
partly linked to the therapeutic approach with different surgi-
cal techniques and a wide range of downtime rates [32].
In the decathlon and heptathlon, there are high downtime
rates of up to 13 weeks caused by musculoskeletal injuries, the
most common affecting the thigh [19] (as in this study), leading
to high dropout rates as explosive run and jump events are the
key risk events on the first competition day, often impeding the
athlete from completing the full competition [33].
Another injury type with high time loss rates was fracture
of the foot, seen especially in middle-distance runners.
Scientific evidence reveals the highest incidence of overuse
fractures in track and field athletes caused by high volumes of
repetitive submaximal forces [34]. Acute fractures of traumatic
origin occur in < 5% of cases [3], as it could be the case for
those seen in jumping sports in our study. Depending on the
stress fracture type (low-risk or high-risk), a restrictive to
aggressive therapy regime is usually applied to prevent non-
union or complete fractures leading to varying time loss
rates [35].
Reduction of sporting performance
In all reported injuries, approximately 20% of the athletes claimed
a persistent reduction in sporting performance. In sprinting ath-
letes, there was even a 100% observed reduction because of foot
ligament injuries, among which plantar fasciitis and tendinopa-
thies of the Achilles tendon in particular could be counted. Elbow
injuries are well-known in overhead athletes, and the treatment
for common UCL injuries is usually non-operative with a well-
structured rehabilitation program [36]. Considering the outcomes
following UCL reconstruction over the last few years, Wilk et al.
summarized high success rates of 79–97% with a RTS at the same
level or better. Dines et al. noted a return to pre-injury level after
15 months for javelin throwers who underwent surgical recon-
struction after UCL reconstruction [37]. Injuries to the knee
caused a major reduction in performance in running and throw-
ing athletes in track and field, among which injuries to the
cartilage and meniscus were the most common.
Limitations
The study has limitations to be considered for a conclusive
statement. First, it does not include a prospective or long-
itudinal design. The data was documented retrospectively
8C. LAMBERT ET AL.
and was self-reported by the athletes. This could result in an
over- or under-reporting of injuries. Considering performance
reduction after meniscus injury and time loss after cartilage
injury, the question of operative or conservative treatment
was not raised. It can be assumed that different treatment
methods would result in different outcome results. No spe-
cific differentiation between the different anatomic muscle
location of thigh injuries was made. Therefore it could only
be speculated that most of them were hamstring injuries.
Beside the injuries to the knee cartilage and meniscus, there
is a third group of knee injuries, which is not further specified.
In the survey no difference between overuse and acute inju-
ries were recorded. This would have been particularly inter-
esting for the assessment of foot ligament injuries.
Conclusion
When assessing time loss and performance reduction after injures
in athletics, there are discipline-specific injury patterns with foot
ligament injuries causing the highest performance reduction in
sprint, and the longest time loss rates were noted for throwing
sports. This study points out the significance of training injuries,
highlighting the need for future investigations on this subject to
adapt training management and improve medical care and reha-
bilitation with respect to every athletic discipline.
Disclosure statement
No potential conflict of interest was reported by the authors.
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