Original article
Br J Sports Med: first published as 10.1136/bjsports-2019-100717 on 13 November 2019. Downloaded from http://bjsm.bmj.com/ on November 14, 2019 at University of California San
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Correspondence to
Dr Pascal Edouard, University
Hospital of Saint-­Etienne, Saint-­
Etienne 42 055, France;
P​ ascal.​Edouard42@​gmail.​com
Accepted 6 November 2019
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by BMJ.
To cite: Edouard P,
Navarro L, Branco P, et al.
Br J Sports Med Epub ahead
of print: [please include Day
Month Year]. doi:10.1136/
bjsports-2019-100717
Injury frequency and characteristics (location, type,
cause and severity) differed significantly among
athletics (‘track and field’) disciplines during 14
international championships (2007–2018):
implications for medical service planning
Pascal Edouard ‍ ‍ ,1,2,3,4,5 Laurent Navarro,6 Pedro Branco,4,7 Vincent Gremeaux,3,8
Toomas Timpka ‍ ‍ ,9 Astrid Junge10,11
Abstract
Objective  To analyse differences between athletic
disciplines in the frequency and characteristics of injuries
during international athletics championships.
Methods  Study design, injury definition and data
collection procedures were similar during the 14
international championships (2007–2018). National
medical teams and local organising committee
physicians reported all newly incurred injuries daily on a
standardised injury report form. Results were presented
as number of injuries and number of injuries per 1000
registered athletes, separately for male and female
athletes, and for each discipline.
Results  From a total of 8925 male and 7614 female
registered athletes, 928 injuries were reported in male
and 597 in female athletes. The discipline accounting
for the highest proportion of injuries was sprints, for
both men (24%) and women (26%). The number of
injuries per 1000 registered athletes varied between
disciplines for men and women: highest in combined
events for male athletes (235 (95% CI 189 to 281)) and
female athletes (212 (95% CI 166 to 257)), and lowest
for male throwers (47 (95% CI 35 to 59)) and female
throwers (32 (95% CI 21 to 43)) and for female race
walkers (42 (95% CI 19 to 66)). Injury characteristics
varied significantly between disciplines for location,
type, cause and severity in male and female athletes.
Thigh muscle injuries were the main diagnoses in the
disciplines sprints, hurdles, jumps, combined events and
race walking, lower leg muscle injuries in marathon
running, lower leg skin injury in middle and long distance
running, and trunk muscle and lower leg muscle injuries
in throws.
Conclusions  Injury characteristics differed substantially
between disciplines during international athletics
championships. Strategies for medical service provision
(eg, staff, facilities) during athletics championships
should be discipline specific and be prepared for
targeting the main injuries in each discipline.
Introduction
Competing and training in athletics (‘track and
field’) carries the risk of injury,1 2 especially in
international athletics championships where about
10 injuries per 1000 registered athletes have been
reported,3 with a slightly higher risk in male than
Edouard P, et al. Br J Sports Med 2019;0:1–9. doi:10.1136/bjsports-2019-100717
female athletes and sex related differences in injury
characteristics.4
Athletics comprises several disciplines with
different physical, mechanical, technical and
psychological demands, which can potentially lead
to different constraints on the musculoskeletal
system.1–4 During international athletics champion-
ships lasting 3–9 days, the number of injuries per
1000 registered athletes differed by sex and athletic
Francisco (UCSF). Protected by copyright.
discipline.3–8 Differences between disciplines in
injury location were also observed3 but their poten-
tial discipline specific differences between male
and female athletes were not reported. Differences
in other injury characteristics (eg, type) were not
reported. Thus, the specific injury patterns (ie,
combinations of the characteristics) in different
athletic disciplines have not been described for high
level athletes during international championships,
although such information is of major interest.3 4
We investigated differences among athletic disci-
plines in the frequency and characteristics of inju-
ries sustained by male and female athletes during
international athletics championships.
Methods
The study used a total population design in which
eligible participants were all athletes registered for
14 international athletics championships.
►► World Outdoor Championships 2007, 2009,
9 6
2011,5 201310;
►► European Outdoor Championships 2012,
7
2014, 2016, 2018;
►► World Indoor Championships 2014; and
►► European Indoor Championships 2009,
2011,11 2013,8 2015, 2017.
The analyses were based on an injury database
comprising data collected using the same study
design, injury definition and data collection proce-
dures (previously described in detail3–9 11–13). The
database was updated and extended from previous
studies.3 4 All injury reports in the database were
anonymous—that is, they were not associated
with individual athletes. There was no patient or
public involvement. The study was reviewed and
approved by the Saint-­Etienne University Hospital
ethics committee (institutional review board:
IORG000481).
   1
 Original article
Newly incurred injuries during the athletics championships
were reported daily by the national medical teams (physicians
and/or physiotherapists) and/or by the local organising committee
physicians. Specifically, the instructions were to report 'all muscu-
loskeletal injuries (traumatic and overuse) and concussion newly
incurred during competition or training regardless of the conse-
quences with respect to the athlete’s absence from competition or
training'.3 4 9 13 In cases where a single incident resulted in more
than one injured body part and/or type of injury, each body part
and/or type injury was counted as a separate injury.4 12 We used
the classification for location, type, cause, severity, circumstance
and discipline (event) described in the consensus statement for
epidemiological studies in athletics.13 Location was grouped into
head, trunk, upper extremities and were detailed for the lower
extremities. Type was grouped according to the type of tissue (ie,
muscle, tendon, ligament, articular, bone, skin and other). Cause
was grouped into overuse, traumatic and other. Preliminary
diagnoses were constructed using the combination of location
and type for each injury.
National medical team participation, athletes’ coverage,
response rate and data completeness were reported according
to Edouard et al.14 The total number of registered athletes was
calculated by totalling the athlete registrations at each of the
14 championships using the list of registered athletes provided
by the International Association of Athletics Federations or the
European Athletics Association for each championship (ie, if an
athlete registered for more than one championship they were
counted for each championship).4 12 15 We analysed the number
of athletes who registered for more than one championship.
Athlete days were calculated by multiplying the number of
athletes registered for a championship by the number of days of
the respective championship.15–17
Results are presented as number of injuries, number of injuries
per 1000 registered athletes and number of injuries per 1000
athlete days (with 95% CI)3 4 12 13 for all and time loss inju-
ries during training and competition, separately for male and
female athletes,4 and for each discipline, for all championships
as well as for outdoor and indoor championships. We thereafter
analysed differences in the distribution of injury characteristics
(ie, location, type, cause and severity) between the nine disci-
plines separately for male and female athletes for all champion-
ships. Finally, for each discipline, we analysed the distribution
of injury characteristics for all recorded injuries between male
and female athletes, as well as differences between outdoor and
indoor championships for male and female athletes separately.
We used χ2 tests or Fisher’s exact test where appropriate, and
Cramer’s V method for estimation of effect size (small, medium
or large).18 19 Significance was accepted at p<0.05. Bonferroni
corrections were made to control for multiple tests.
Results
Study participation and exposures
On average, 86.8% of all national medical teams, covering
81.0% of registered athletes, participated in the injury surveil-
lance project and returned 91.6% of the expected report forms.
The completeness of injury data use in the present study aver-
aged 98.2%. No athlete refused to allow their data to be used
for scientific research.
A total of 8925 male and 7614 female athlete entries were
registered at the 14 championships, comprising a total of 78
days (19 days for the 6 indoor and 59 for the 8 outdoor cham-
pionships). Most athletes (2339 men and 2090 women) regis-
tered for 1 championship, 898 men and 790 women athletes
2 Edouard P, et al. Br J Sports Med 2019;0:1–9. doi:10.1136/bjsports-2019-100717
Br J Sports Med: first published as 10.1136/bjsports-2019-100717 on 13 November 2019. Downloaded from http://bjsm.bmj.com/ on November 14, 2019 at University of California San
registered for 2 championships, 478 and 372 for 3 champion-
ships, 263 and 216 for 4 championships, 139 and 119 for 5
championships, 82 and 65 for 6 championships, 58 and 50 for 7
championships, 27 and 29 for 8 championships, 19 and 20 for
9 championships, 8 and 9 for 10 championships, 15 and 6 for
11 championships, 4 and 2 for 12 championships, and 2 and 2
for 13 championships (information was missing for 5 men and
11 women). The duration differed between indoor (mean 3.2
days, range 3–4) and outdoor (mean 7.4 days, range 5–9) cham-
pionships. Most athletes were registered for sprints, followed by
jumps and throws (table 1).
Number of injuries
A total of 1530 injuries were reported during the 14 champion-
ships, 928 in male and 597 in female athletes (information on sex
was missing for 5 injuries). Most of the injuries were sustained
in sprints by both male (24.2%) and female (26.1%) athletes,
followed by jumps (15.8%) and middle distances (10.8%) for
male athletes, and long distances (14.1%) and jumps (11.9%)
for female athletes (table 1 and online supplementary tables 1
and 2).
The number of injuries per 1000 registered athletes and per
1000 athlete days varied between disciplines for male (figure 1,
table 2 and online supplementary tables 3 and 5) and female
Francisco (UCSF). Protected by copyright.
athletes (figure 1, table 2 and online supplementary tables 4 and
5). Overall, the number of injuries per 1000 registered athletes
and 1000 athlete days was highest in combined events for male
and female athletes, and lowest in male and female throwers and
in female race walkers (figure 1, table 2 and online supplemen-
tary tables 3 to 5).
Interdiscipline differences in injury characteristics
Regarding all injuries recorded in the outdoor and indoor
championships, the distribution of injury characteristics varied
between the disciplines in male athletes by location (p<0.001,
large), type (p<0.001, large), cause (p<0.001, large) and
severity (p<0.001, medium), and in female athletes by location
(p<0.001, large), type (p<0.001, large), cause (p<0.001, large)
and severity (p=0.04, medium) (figures 2–4 and online supple-
mentary tables 6 and 7).
Injury characteristics
Sprints
Most injuries in male sprinters were located in the thigh (52.0%),
affected the muscles (67.6%), were caused by overuse (42.7%)
or trauma (39.1%), and were expected to lead to no time loss
(39.1%), time loss of up to 7 days (24.0%) or time loss of 828
days (22.7%).
Most injuries in female sprinters were located in the thigh
(37.8%), the foot (12.8%) or the trunk (11.5%), affected muscles
(49.4%) or skin (15.4%), were caused by overuse (50.6%) and
were expected to lead to no time loss (50.0%) or time loss of up
to 7 days (23.1%).
Sex related differences in the distribution of injury location
(p=0.002, large) and injury type (p<0.001, large) were observed
but not with regards to injury cause or severity. The injury causes
differed between outdoor and indoor championships (p=0.008,
medium) for female athletes but not for injury location, type or
severity. There were no significant differences in injury charac-
teristics between outdoor and indoor championships for male
athletes.
 Original article

Br J Sports Med: first published as 10.1136/bjsports-2019-100717 on 13 November 2019. Downloaded from http://bjsm.bmj.com/ on November 14, 2019 at University of California San
Table 1  Number of registered athletes and reported injuries according to type of championships, sex and discipline
Combined Middle Long Race
Total Sprints Hurdles Jumps Throws events distances distances Marathon walking
N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%) N (%)
Registered athletes
All
 Total 16 539 (100.0) 4449 (26.9) 1461 (8.8) 2885 (17.4) 2155 (13.0) 635 (3.8) 1685 (10.2) 1449 (8.8) 1014 (6.1) 806 (4.9)
 Men 8925 (100.0) 2366 (26.5) 752 (8.4) 1507 (16.9) 1164 (13.0) 328 (3.7) 943 (10.6) 793 (8.9) 550 (6.2) 522 (5.8)
 Women 7614 (100.0) 2083 (27.4) 709 (9.3) 1378 (18.1) 991 (13.0) 307 (4.0) 742 (9.7) 656 (8.6) 464 (6.1) 284 (3.7)
Outdoor
 Men 7034 (100.0) 1835 (26.1) 585 (8.3) 998 (14.2) 1015 (14.4) 243 (3.5) 629 (8.9) 657 (9.3) 550 (7.8) 522 (7.4)
 Women 6024 (100.0) 1613 (26.8) 547 (9.1) 918 (15.2) 893 (14.8) 224 (3.7) 515 (8.5) 566 (9.4) 464 (7.7) 284 (4.7)
Indoor
 Men 1891 (100.0) 531 (28.1) 167 (8.8) 509 (26.9) 149 (7.9) 85 (4.5) 314 (16.6) 136 (7.2) 0 (0.0) 0 (0.0)
 Women 1590 (100.0) 470 (29.6) 162 (10.2) 460 (28.9) 98 (6.2) 83 (5.2) 227 (14.3) 90 (5.7) 0 (0.0) 0 (0.0)
Injuries
All
 Total 1530 (100.0) 382 (25.0) 140 (9.2) 218 (14.2) 88 (5.8) 142 (9.3) 163 (10.7) 182 (11.9) 141 (9.2) 72 (4.7)
 Men 928 (100.0) 225 (24.2) 80 (8.6) 147 (15.8) 55 (5.9) 77 (8.3) 100 (10.8) 98 (10.6) 86 (9.3) 60 (6.5)
 Women 597 (100.0) 156 (26.1) 59 (9.9) 71 (11.9) 32 (5.4) 65 (10.9) 63 (10.6) 84 (14.1) 55 (9.2) 12 (2.0)
Outdoor
 Men 798 (100.0) 198 (24.8) 59 (7.4) 118 (14.8) 51 (6.4) 60 (7.5) 85 (10.7) 81 (10.2) 86 (10.8) 60 (7.5)

Francisco (UCSF). Protected by copyright.

 Women 524 (100.0) 138 (26.3) 42 (8.0) 57 (10.9) 31 (5.9) 58 (11.1) 56 (10.7) 75 (14.3) 55 (10.5) 12 (2.3)
Indoor
 Men 130 (100.0) 27 (20.8) 21 (16.2) 29 (22.3) 4 (3.1) 17 (13.1) 15 (11.5) 17 (13.1) 0 (0.0) 0 (0.0)
 Women 73 (100.0) 18 (24.7) 17 (23.3) 14 (19.2) 1 (1.4) 7 (9.6) 7 (9.6) 9 (12.3) 0 (0.0) 0 (0.0)
Values are number (%).
The distribution of registered athletes in the different disciplines differed significantly between male and female athletes for all, outdoor and indoor championships (p<0.001,
small), and between indoor and outdoor championships for male and female athletes (p<0.001, medium).
The distribution of injuries in the different disciplines differed significantly between male and female athletes for all and outdoor championships (p=0.01, medium), but not for
indoor championships (p>0.05).
Information on sex was missing for 5 injuries, including 2 where information on discipline was also missing.

Hurdles
Most injuries in male hurdlers were located in the thigh (37.5%)
or hip and groin (12.5%), affected muscles (51.3%) or skin
(23.8%), were caused by trauma (51.3%) and were expected to
lead to no time loss (40.0%) or time loss of 8–28 days (26.3%).
Most injuries in female hurdlers were located in the thigh
(22.0%), knee (18.6%) or upper extremities (16.9%), affected
skin (30.5%), muscles (27.1%) or ligaments (23.8%), were
caused by trauma (52.5%) and were expected to lead to no time
loss (40.7%), time loss of up to 7 days (27.1%) or time loss of
8–28 days (20.3%).
There were no significant differences in injury characteristics
between male and female hurdlers, or between outdoor and
indoor championships.
Jumps
Most injuries in male jumpers were located in the thigh (24.5%),
foot (12.9%), knee (12.2%) or ankle (11.6%), affected muscles
(40.1%), tendons (15.0%) or joints (13.6%), were caused by
overuse (38.8%) or trauma (38.8%), and were expected to lead
to no time loss (43.5%), time loss of up to 7 days (21.3%) time
loss of 8–28 days (21.8%).
Most injuries in female jumpers were located in the thigh
(19.7%) or trunk (14.1%), affected muscles (35.2%), skin
(18.3%) or tendons (15.5%), were caused by trauma (43.7%)
and were expected to lead to no time loss (50.7%).
There were no significant differences in injury characteris-
tics between male and female jumpers, or between outdoor and
indoor championships.
Throws
Most injuries in male throwers were located in the upper extrem-
ities (20.0%), trunk (20.0%) or knee (16.4%), affected muscles
(47.3%) or ligaments (21.8%), were caused by overuse (49.1%)
and were expected to lead to no time loss (49.1%) or time loss
of 8–28 days (27.3%).
Most injuries in female throwers were located in the trunk
(28.1%), upper extremities (18.8%) or lower leg (15.6%),
affected muscles (31.3%), tendons (18.8%) or ligaments
(18.8%), were caused by overuse (53.1%) or trauma (40.6%),
and were expected to lead to no time loss (53.1%).
There were no significant differences in injury characteris-
tics between male and female throwers. Comparisons between
outdoor and indoor championships were not performed due to
the small number of indoor injuries.
Combined events
Most injuries in male athletes in combined events were located
in the thigh (19.5%), ankle (15.6%) or knee (14.3%), affected
muscles (29.9%), skin (22.1%) or tendons (18.2%), were caused
by trauma (42.9%) or overuse (36.4%), and were expected to
lead to no time loss (40.3%) or time loss of 8–28 days (20.8%).
Most injuries in female athletes in combined events were
mostly located in the thigh (21.5%), knee (16.9%) or trunk
(13.8%), affected muscles (38.5%), ligaments (27.7%) or
tendons (12.3%), were caused by overuse (40.0%) or trauma
(40.0%), and were expected to lead to no time loss (36.9%),
time loss of up to 7 days (21.5%) or time loss of 8–28 days
(21.5%).

Edouard P, et al. Br J Sports Med 2019;0:1–9. doi:10.1136/bjsports-2019-100717 3

 Original article

Br J Sports Med: first published as 10.1136/bjsports-2019-100717 on 13 November 2019. Downloaded from http://bjsm.bmj.com/ on November 14, 2019 at University of California San
Francisco (UCSF). Protected by copyright.

Figure 1  Number of reported injuries and time loss injuries per 1000 registered male (blue) and female (red) athletes for each discipline, in (A) all
(outdoor and indoor) championships and (B) separately for outdoor and indoor championships and for competition and training. The dot represents
the value of the number of reported injuries per 1000 registered athletes, and the size of the ellipsoid form represents the 95% CI.

4 Edouard P, et al. Br J Sports Med 2019;0:1–9. doi:10.1136/bjsports-2019-100717

 Original article

Br J Sports Med: first published as 10.1136/bjsports-2019-100717 on 13 November 2019. Downloaded from http://bjsm.bmj.com/ on November 14, 2019 at University of California San
Table 2  Number of reported injuries (all injuries) per 1000 registered athletes in male and female athletes according to discipline
Combined Middle
Total general Sprints Hurdles Jumps Throws events distance Long distances Marathon Race walking
All
championships
Men 104.0 (97.6 to 95.1 (83.3 to 106.4 (84.3 to 97.5 (82.6 to 47.3 (35.1 to 234.8 (188.9 to 106.0 (86.4 to 123.6 (100.7 to 156.4 (126.0 to 114.9 (87.6 to
110.3) 106.9) 128.4) 112.5) 59.4) 280.6) 125.7) 146.5) 186.7) 142.3)
Women 78.4 (72.4 to 74.9 (63.6 to 83.2 (62.9 to 51.5 (39.9 to 32.3 (21.3 to 211.7 (166.0 to 84.9 (64.8 to 128.0 (102.5 to 118.5 (89.1 to 42.3 (18.9 to
84.4) 86.2) 103.5) 63.2) 43.3) 257.4) 105.0) 153.6) 147.9) 65.7)
Outdoor
championships
Men 113.4 (106.0 to 107.9 (93.7 to 100.9 (76.5 to 118.2 (98.2 to 50.2 (36.8 to 246.9 (192.7 to 135.1 (108.4 to 123.3 (98.1 to 156.4 (126.0 to 114.9 (87.6 to
120.9) 122.1) 125.3) 138.3) 63.7) 301.1) 161.9) 148.4) 186.7) 142.3)
Women 87.0 (79.9 to 85.6 (71.9 to 76.8 (54.5 to 62.1 (46.5 to 34.7 (22.7 to 258.9 (201.6 to 108.7 (81.9 to 132.5 (104.6 to 118.5 (89.1 to 42.3 (18.9 to
94.1) 99.2) 99.1) 77.7) 46.7) 316.3) 135.6) 160.4) 147.9) 65.7)
Indoor
championships
Men 68.7 (57.3 to 50.8 (32.2 to 125.7 (75.5 to 57.0 (36.8 to 26.8 (0.9 to 200.0 (115.0 to 47.8 (24.2 to 125.0 (69.4 to
80.2) 69.5) 176.0) 77.1) 52.8) 285.0) 71.4) 180.6)
Women 45.9 (35.6 to 38.3 (20.9 to 104.9 (57.7 to 30.4 (14.7 to 10.2 (-9.7 to 84.3 (24.6 to 30.8 (8.3 to 100.0 (38.0 to
56.2) 55.6) 152.1) 46.1) 30.1) 144.1) 53.3) 162.0)
Values are number (95% CI).

There were no significant differences in injury characteristics Middle distances

between male and female athletes in combined events. Compar- Most injuries in male middle distance runners were mostly
isons between outdoor and indoor championships were not located in the lower leg (30.0%) or foot (18.0%), affected skin

Francisco (UCSF). Protected by copyright.

performed due to small number of indoor injuries.

Figure 2  Distribution of injury characteristics by location (A), type (B), cause (C) and severity (D), according to discipline, in male athletes in all
championships (data are percentage of all injuries per discipline).

Edouard P, et al. Br J Sports Med 2019;0:1–9. doi:10.1136/bjsports-2019-100717 5

 Original article
Figure 3  Distribution of injury characteristics by location (A), type (B), cause (C) and severity (D), according to discipline, in female athletes in all
championships (data are percentage of all injuries per disciplines).
(53.0%) or muscles (19.0%), were caused by trauma (57.0%)
and were expected to lead to no time loss (69.0%).
Most injuries in female middle distance runners were located
in the lower leg (28.6%) or thigh (20.6%), affected skin (47.6%),
muscles (19.0%) or tendons (17.5%), were caused by trauma
(47.6%) and were expected to lead to no time loss (58.7%)
There were no significant differences in the distribution of
injury characteristics between male and female athletes in middle
distances. Comparisons between outdoor and indoor champi-
onships were not performed due to the small number of indoor
injuries.
Long distances
Most injuries in male long distance runners were located in the
lower leg (40.8%), affected skin (48.0%) or muscles (24.5%),
were caused by trauma (53.1%) and were expected to lead to no
time loss (49.0%) or time loss of up to 7 days (25.5%).
Most injuries in female long distance runners were located in
the lower leg (36.9%), affected skin (42.9%) or muscles (29.8%),
were caused by trauma (48.8%) and were expected to lead to no
time loss (39.3%), time loss of up to 7 days (29.8%) or time loss
of 8–28 days (23.8%).
There were no significant differences in injury characteristics
between male and female long distance runners. Comparisons
6 Edouard P, et al. Br J Sports Med 2019;0:1–9. doi:10.1136/bjsports-2019-100717
Br J Sports Med: first published as 10.1136/bjsports-2019-100717 on 13 November 2019. Downloaded from http://bjsm.bmj.com/ on November 14, 2019 at University of California San
Francisco (UCSF). Protected by copyright.
between outdoor and indoor championships were not performed
due to the small number of indoor injuries.
Marathon
Most injuries in male marathon runners were located in the foot
(23.3%), lower leg (22.1%) or thigh (17.4%), affected muscles
(50.0%), were caused by overuse (69.8%) and were expected to
lead to no time loss (36.0%) or time loss of up to 7 days (30.2%).
Most injuries in female marathon runners were located in
the foot (23.6%), lower leg (21.8%) or thigh (14.5%), affected
muscles (30.9%), skin (21.8%), ligaments (18.2%) or tendons
(16.4%), were caused by overuse (69.1%) and were expected to
lead to no time loss (40.0%) or time loss of up to 7 days (27.3%).
There were no significant differences in injury characteristics
between male and female marathon runners.
Race walking
Most injuries in male race walkers were located in the thigh
(30.0%) or trunk (15.0%), affected muscles (61.7%), were
caused by overuse (75.0%) and were expected to lead to no time
loss (33.3%) or time loss of up to 7 days (30.0%).
Most injuries in female race walkers were located in the foot
(33.3%) or thigh (25.0%), affected skin (50.0%) or muscles
 Original article

Br J Sports Med: first published as 10.1136/bjsports-2019-100717 on 13 November 2019. Downloaded from http://bjsm.bmj.com/ on November 14, 2019 at University of California San
Francisco (UCSF). Protected by copyright.
Figure 4  Number of reported injuries per 1000 registered athletes (represented by the size of the half disc) in all championships (outdoor and
indoor), based on nine athletic disciplines, according to sex (male athletes represented by downward facing half disc and female athletes by upward
facing half disc), preliminary diagnoses (location and type) and severity (visualised by a colour scale presenting the mean of the estimated absence in
days, no time loss represented by the green colour and important time loss (mean time loss ≥30 days) by the purple colour).

(25.0%), were caused by overuse (66.7%) and were expected to
lead to no time loss (50.0%) or time loss of 7–28 days (25.0%).
Comparisons between male and female athletes were not
performed due to small number of injuries in race walkers.
Discussion
The main finding of the present study, based on data from 14
international athletics championships, was that substantial
differences between disciplines were observed in the frequency
and characteristics of reported injuries: (1) 25% of injuries were
reported in sprints, (2) the highest number of injuries per 1000
registered athletes and per 1000 athlete days were observed
in combined events, followed by marathon and long distance
running in both male and female athletes, and (3) the specific
injury patterns, taking injury location, type, cause, severity and
diagnosis into account, differed between the disciplines.
Discipline related differences in the frequency of injuries
The number of injures differed between disciplines, confirming
previous studies during one5–8 or several3 4 international athletics

Edouard P, et al. Br J Sports Med 2019;0:1–9. doi:10.1136/bjsports-2019-100717 7

 Original article
championships. During athletics championships, attention
should be focused on disciplines with the highest total number
of injuries (sprints) and the highest number of injuries per 1000
registered athletes or 1000 athlete days (combined events, and
marathon and long distance running). This can be done 1) by
detecting athletes with injury complaints during the month
before the championships,10 20 and 2) during the whole season,
by monitoring athletes and adopting injury prevention strategies
targeting the main injuries of the respective discipline, in addi-
tion to the performance focus training in order to prepare for
the championships.
Although athletes are focused mainly on competition during
championships, some training injuries were reported. This
could be explained by the fact that athletes did not compete
every day but exercised/trained once or twice each day. Training
injuries during championships are few but do exist, and there-
fore require attention. Medical services should be available in
the warmup area and training ground during championships in
order to provide efficient secondary injury prevention by rapid
treatment.
Discipline related differences in the characteristics of injuries
The discipline specific injury characteristics reported in the
present study are in agreement with the fact that athletics is
composed of several different disciplines, leading to different
injuries. Our results on discipline specific injury characteristics
illustrate the specific constraints of each discipline. Short distance
running disciplines were exposed to thigh muscle injuries while
long distance running disciplines were exposed to lower leg
muscle injuries. Disciplines involving plyometrics (ie, jumping
and landing, in jumps or combined events) were associated with
musculoskeletal injuries of different locations and types.
These results are in agreement with previous studies on inju-
ries in athletics during the whole season, reporting discipline
related differences in injury characteristics (location and/or diag-
nosis).21–26 However, these studies provided only descriptive
analyses of the injury characteristics according to disciplines,
except for one21 which focused on club level running disciplines.
In summary, these studies reported that athletes participating in
sprints suffered more thigh/hamstring,21–26 Achilles tendon23 26
and/or back injuries22; in hurdles, thigh24 and/or lower leg inju-
ries22; in middle and long distance running, lower leg,22 24–26 foot/
ankle/Achilles tendon,21 23 25 26 back/hip,21 hamstring23 and/or
knee injuries23–25; in jumps, thigh/hamstring,22 24–26 knee,22 back24
and/or Achilles injuries23 25 26; in throws, back,22 23 25 26 upper
extremity,23 ankle22 and/or knee injuries25 26; and in combined
events, thigh,24–26 back,24 upper extremity,23 knee25 and/or foot/
ankle/Achilles injuries.26 These injury locations are similar to our
findings. This could be interpreted as specific disciplines lead
to specific constraints and injuries whatever the circumstances
(entire season or championships).
Methodological considerations
A strength of the present study was the quality of the meth-
odology, regarding team participation, response rates and
completeness of the data.14 Another strength was the large
sample size (16 539 registered athletes, 1530 injuries) allowing
more representative results, and increasing the opportunities for
indepth analyses.
However, we calculated the number of reported injuries,
which is different from the number of injury events and injured
athletes. Some athletes could have sustained more than one injury
during one injury event and more than one injury event during
8 Edouard P, et al. Br J Sports Med 2019;0:1–9. doi:10.1136/bjsports-2019-100717
Br J Sports Med: first published as 10.1136/bjsports-2019-100717 on 13 November 2019. Downloaded from http://bjsm.bmj.com/ on November 14, 2019 at University of California San
one championship. This implies that the injury numbers should
not be interpreted as risk indicators at the level of individual
athletes. Due to the structure of the database based on require-
ments from the research ethics committee, it was not possible
to perform clustering (by team or country). Injury severity was
assessed by the estimated number of days of absence from sport,
which has been reported as having low inter-­examiner reliability,
suggesting caution in its interpretation.27 Injury cause should
also be interpreted with caution, given the low to moderate
inter-­examiner reliability, and the number of injuries classified as
'others' before the consensus statement on athletics injury epide-
miology.13 These results represented 3–9 days of the season in
the specific context of international championships and are not
representative of the whole season in high level athletes. Our
study captured high quality data but only during a small part of
the season, and more studies on injuries during the entire season
are needed in this population of high level athletes.28 Based on
the total population study design, we did not formally calculate
a priori sample sizes for the analyses. However, post-­hoc analysis
found that the sizes of the samples used in the analyses were
acceptable as the confidence intervals generated were sufficiently
small. We performed multiple comparisons, and thus potential
confounding and effect modifying factors across championships
could exist, although we applied Bonferroni corrections. Finally,
the data may lack generalisability and control for dependent data
Francisco (UCSF). Protected by copyright.
across athletes included in multiple championships.
Conclusions and practical implications
The characteristics of injuries in international athletics cham-
pionships differed between disciplines. This should be taken
into account when planning medical services, including local
organisation and medical teams, in the preparation and during
these major sports events. The results also highlight the disci-
plines and injuries which should be focused on in future studies
on risk factors and mechanisms, and on prevention measures
What are the new findings?
►► Athletic disciplines differed in the frequency of injuries
reported during international athletics championships: the
discipline with the highest total number of injuries was
sprints (25% of all injuries) while the highest number of
injuries per 1000 registered athletes were in combined
events, and marathon and long distance running, for both
male and female athletes.
►► Injury characteristics differed significantly between disciplines
with a specific injury pattern for each discipline.
►► Thigh muscle injuries were the main diagnoses in sprints,
hurdles, jumps, combined events and race walking, lower leg
muscle injuries in marathon running, lower leg skin lesions
in middle and long distance running, and trunk muscle and
lower leg muscle injuries in throws.
How might it impact on clinical practice in the near
future?
►► Strategies for medical service provision, including local
organisation, medical teams, supplies, and facilities, in the
preparation of and during athletics championships should
be discipline specific and be prepared for targeting the main
injuries in each discipline as they appear in the programme.

(eg, combined events, endurance disciplines, thigh (especially
hamstring)12 muscle injuries, and lower leg muscle and skin
injuries).
Author affiliations
1
Inter‐university Laboratory of Human Movement Science (LIBM EA 7424), University
of Lyon, University Jean Monnet, Saint Etienne, France
2
Department of Clinical and Exercise Physiology, Sports Medicine Unit, University
Hospital of Saint-­Etienne, Saint-­Etienne, France
3
Swiss Olympic Medical center, Centre de médecine du sport, Division de médecine
physique et réadaptation, Centre Hospitalier Universitaire Vaudois, Lausanne,
Switzerland
4
European Athletics Medical & Anti Doping Commission, European Athletics
Association (EAA), Lausanne, Switzerland
5
Medical Commission, French Athletics Federation (FFA), Paris, France
6
Mines Saint-­Etienne, INSERM, U 1059 Sainbiose, CIS, Univ Lyon, Univ Jean Monnet,
Saint-E­ tienne, France
7
Health and Science Commission, International Association of Athletics Federations
(IAAF), Monaco, Monaco
8
Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
9
Athletics Research Center, Linköping University, Linköping, Sweden
10
Prevention, Health Promotion and Sports Medicine, MSH Medical School Hamburg,
Hamburg, Germany
11
Swiss Concussion Centre, Schulthess Klinik, Zurich, Switzerland
Acknowledgements  The authors thank the medical staff of the national teams
and the physicians attached to the competition organising committees who collected
the data for this project.
Contributors  PE: substantial contributions to the conception and design of the
study, collection, analysis and interpretation of the data, drafting, writing and
revising of the manuscript, and approval of the final version to be published. LN:
substantial contributions to the analysis and interpretation of the data, developing
the figures, revision of the manuscript, and approval of the final version to be
published. PB: substantial contributions to the conception and design of the study,
collection and interpretation of the data, revision of the manuscript, and approval
of the final version to be published. VG: substantial contributions to the revision of
the manuscript, and approval of the final version to be published. TT: substantial
contributions to the analysis and interpretation of the data, writing, revision of
the manuscript, and approval of the final version to be published. AJ: substantial
contributions to the conception and design of the project, analysis and interpretation
of the data, writing and revision of the manuscript, and approval of the final version
to be published.
Funding  The authors have not declared a specific grant for this research from any
funding agency in the public, commercial or not-­for-­profit sectors.
Competing interests  None declared.
Patient consent for publication  Not required.
Ethics approval  The study was reviewed and approved by the Saint-­Etienne
University Hospital ethics committee (institutional review board: IORG0004981).
Provenance and peer review  Not commissioned; externally peer reviewed.
Data availability statement  No data are available.
ORCID iDs
Pascal Edouard http://o​ rcid.​org/​0000-​0003-1​ 969-​3612
Toomas Timpka http://​orcid.​org/​0000-​0001-6​ 049-​5402
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