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BJSM Online First, published on July 29, 2017 as 10.1136/bjsports-2017-097956
Original article

Sports injury and illness incidence in the Rio de

Janeiro 2016 Olympic Summer Games: A prospective
study of 11 274 athletes from 207 countries
Torbjørn Soligard,1,2 Kathrin Steffen,3 Debbie Palmer,4,5 Juan Manuel Alonso,6
Roald Bahr,3 Alexandre Dias Lopes,7 Jiri Dvorak,8 Marie-Elaine Grant,9
Willem Meeuwisse,2 Margo Mountjoy,10 Leonardo Oliveira Pena Costa,11
Natalia Salmina,12 Richard Budgett,1 Lars Engebretsen1,3,13

►► Additional material is Abstract of disease and hospital admission.3–7 However,

published online only. To view Objective To describe the pattern of injuries and concomitantly, they run a higher risk of musculo-
please visit the journal online
(http://d​ x.​doi.o​ rg/​10.​1136/​ illnesses sustained during the Games of the XXXI skeletal disorders and long-term disability after the
bjsports-​2017-​097956). Olympiad, hosted by Rio de Janeiro from 5 to 21 August end of their careers.4 8–11
2016. Systematic injury and illness surveillance is a
For numbered affiliations see Methods We recorded the daily incidence of athlete prerequisite to effective protection of the health
end of article. of the athletes. Epidemiological data contribute
injuries and illnesses (1) through the reporting of all
National Olympic Committee (NOC) medical teams and to better planning and provision of athlete health-
Correspondence to
Torbjørn Soligard, Department (2) in the polyclinic and medical venues by the Rio 2016 care and, importantly, inform the development of
of Medical & Scientific, medical staff. measures to prevent injury and illness.12 13
International Olympic Results In total, 11 274 athletes (5089 women, 45%; Some International Sports Federations or
Committee,Château de Vidy, 6185 men, 55%) from 207 NOCs participated in the research institutes have set up injury and illness
1007 Lausanne, Switzerland; ​ surveillance systems either longitudinally, over one
study. NOC and Rio 2016 medical staff reported 1101
torbjorn.​soligard@​olympic.o​ rg
injuries and 651 illnesses, equalling 9.8 injuries and or more seasons, or in certain main events.14–76 For
Received 19 April 2017 5.4 illnesses per 100 athletes over the 17-day period. Beijing 2008, the IOC developed the IOC injury
Revised 28 June 2017 Altogether, 8% of the athletes incurred at least one surveillance system77 78 which, to account for all
Accepted 29 June 2017 injury and 5% at least one illness. The injury incidence health aspects, was expanded for Vancouver 2010
was highest in BMX cycling (38% of the athletes to also include illnesses.79 Since then, the surveil-
injured), boxing (30%), mountain bike cycling (24%), lance system has been implemented in London
taekwondo (24%), water polo (19%) and rugby (19%), 201280 and Sochi 2014.81 In these Games, the
and lowest in canoe slalom, rowing, shooting, archery, injury and illness incidences have ranged from 9.6
swimming, golf and table tennis (0%–3%). Of the 1101 to 14.0 injuries and from 7.2 to 8.9 illnesses per
injuries recorded, 40% and 20% were estimated to lead 100 athletes.
to ≥1 and >7 days of absence from sport, respectively. Our aim was to describe the incidence and
Women suffered 40% more illnesses than men. Illness characteristics of the sports injuries and illnesses
was generally less common than injury, with the occurring during the Rio 2016 Olympic Summer
highest incidence recorded in diving (12%), open-water Games.
marathon (12%), sailing (12%), canoe slalom (11%),
equestrian (11%) and synchronised swimming (10%).
Illnesses were also less severe; 18% were expected to Methods
result in time loss. Of the illnesses, 47% affected the We employed the IOC injury and illness surveillance
respiratory system and 21% the gastrointestinal system. system for multi-sport events in this prospective
The anticipated problem of infections in the Rio Olympic cohort study.77 We asked all National Olympic
Games did not materialise, as the proportion of athletes Committee (NOC) medical teams to report the daily
with infectious diseases mirrored that of recent Olympic occurrence (or non-occurrence) of athlete injuries
Games (3%). and illnesses on a standardised medical report form
Conclusion Overall, 8% of the athletes incurred at least (online appendix 1). Concurrently, we retrieved the
one injury during the Olympic Games, and 5% an illness, same information on all athletes treated for injuries
which is slightly lower than in the Olympic Summer and illnesses in the polyclinic and all other medical
Games of 2008 and 2012. venues operated by the Organizing Committee
of the Olympic and Paralympic Games Rio 2016
(Rio 2016) medical staff. These data were collected
through an electronic medical record system (GE
Introduction Centricity Practice Solution), which was used for
Routine physical activity elicits a number of health the first time in the Games.
To cite: Soligard T,
benefits, including a reduction in the risk of We used the athlete accreditation number to
Steffen K, Palmer D, et al.
Br J Sports Med Published numerous chronic diseases and premature death.1 control for duplicates resulting from athletes being
2
Online First: [please include Compared with the general population, elite treated for the same condition by both NOC and
Day Month Year]. doi:10.1136/ athletes seem to reap additional health benefits in Rio 2016 medical staff. In such cases, we retained
bjsports-2017-097956 the form of greater life expectancy and lower risk the NOC data.

Soligard T, et al. Br J Sports Med 2017;0:1–8. doi:10.1136/bjsports-2017-097956    1

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Original article
Implementation We provided instructions and examples on how to complete
Four months in advance, we informed the NOCs about the study the form correctly in the instructional booklet. Furthermore, we
by letter. The day before the opening of the Games, we organ- distributed the injury and illness report form in English, French,
ised an information meeting for all NOC medical staff, where we Arabic, Chinese, German, Japanese, Russian and Spanish.
also distributed the daily injury and illness report forms, as well
as an instructional booklet detailing the study protocol (online Confidentiality and ethical approval
appendix 2). We used the athlete accreditation number to query the IOC
Throughout the data collection, we actively followed up the athlete database for the age, gender and nationality of the
NOCs comprising more than 10 participating athletes with injured or ill athlete. We treated all information confidentially
frequent visits to address any questions and encourage contin- and deidentified our database after the Games.
uous reporting during the games. We recorded the response rate The study was reviewed by the Medical Research Ethics
of all the 207 NOCs. Committee of the South-Eastern Norway Regional Health
Authority (2011/388).
Definition of injury and illness
We defined injuries and illnesses as new (ie, pre-existing, not
fully rehabilitated conditions were not recorded) or recurring Data analysis
(athletes having returned to full participation after a previous We calculated the summary measures of injury and illness inci-
condition) musculoskeletal complaints, concussions or other dences (i) according to the formula i=n/e, where n is the number
medical conditions (injuries) or illnesses incurred in competition of injuries or illnesses in competition, training or in total during
or training during the Rio Olympic Games (5–21 August 2016) the study period and e is the respective number of exposed
receiving medical attention, regardless of the consequences (participating) athletes, with incidence proportions presented
with respect to absence from competition or training.77 In cases as injuries/illnesses per 100 athletes. We also calculated the
where a single incident caused multiple injury types, we retained summary measures of injury and illnesses per 1000 athlete-days,
only the most severe diagnosis, as determined by our research where athlete-days correspond to the total number of athletes
team based on all available clinical data, for analysis.80 Severe multiplied by 17 days. We calculated CIs of the risk ratio (RR)
injuries and illnesses were defined as injuries or illnesses esti- of the number of injuries or illnesses between two groups by a
mated to lead to absence from training or competition of more simple Poisson model, assuming constant hazard per group. We
than 1 week. present injury and illness incidences as means and RRs with 95%
CIs. We regarded two-tailed p values <0.05 as significant.
Injury and illness report form
Our NOC injury and illness report form was identical to the Results
one we used in the 2010 (Vancouver), 2012 (London) and In total, 11 274 athletes took part in the Rio Olympic Games.
2014 (Sochi) Olympic Games.79–81 With respect to injuries, we Of these, 5089 were women (45%) and 6185 men (55%). There
recorded the following data: accreditation number, sport and were eight double-starters, meaning athletes who participated in
event, whether the injury occurred in competition or training, two different sports, giving a total of 11 289 athlete exposures
date and time, body part, type, cause and estimated time lost to injury or illness.
from competition or training. We recorded data on illnesses in Throughout the 17 days of the Rio Games, the 207 NOCs
a similar fashion: accreditation number, sport and event, date, submitted 1590 of a maximum of 3519 forms (45%; 97 coun-
affected system, main symptom(s), cause and estimated time loss. tries did not submit any data) (table 1). The response rate of the

Table 1 Response rates, injuries and illnesses in NOCs of different sizes (measured by number of athletes)
<10 10–49 50–99 >99 All
NOCs (athletes) 93 (502) 56 (1341) 24 (1635) 34 (7796) 207 (11 274*)
Injuries (injuries per 100 61 (12.2) 191 (14.2) 139 (8.5) 679 (8.7) 1101† (9.8)
athletes)
Illnesses (illnesses per 100 27 (5.4) 90 (6.7) 51 (3.1) 429 (5.5) 613† (5.4)
athletes)
Report forms submitted (%) 151 (10.0) 584 (61.3) 337 (82.6) 518 (89.6) 1590 (45.2)
Recorded by both NOC and
Rio 2016
Injuries (%) 2 (3.2) 12 (6.3) 16 (11.4) 36 (5.3) 66‡ (6.0)
Illnesses (%) - 1 (1.0) 2 (3.8) 7 (1.5) 10‡ (1.5)
Recorded only by NOCs
Injuries (%) 12 (19.7) 120 (62.8) 72 (51.4) 422 (62.2) 654‡ (59.3)
Illnesses (%) 6 (22.2) 57 (63.3) 34 (66.6) 313 (73.0) 426‡ (69.5)
Recorded only by Rio 2016
Injuries (%) 47 (75.8) 53 (27.6) 48 (34.3) 145 (21.2) 293‡ (26.6)
Illnesses (%) 21 (77.8) 24 (24.2) 13 (24.5) 37 (8.1) 95‡ (14.5)
*15 double-starters excluded.
†NOC is missing for 31 injuries and 16 illnesses.
‡Test for duplicate not possible for 88 injuries and 82 illnesses where accreditation number was missing.
NOC, National Olympic Committee.

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Original article

Box 1 Information on the 221 severe injuries (estimated

absence >7 days), with the sports with the highest
numbers in brackets.

►► 65 muscle strains (33 in athletics, six in football, six in

weightlifting)
►► 57 ligament sprains/ruptures (eight in wrestling, six in
athletics, six in judo, five in artistic gymnastics, five in
weightlifting)
►► 24 fractures (three in hockey, three in rugby, two in boxing,
two in artistic gymnastics, two in mountain bike cycling, two
in road cycling, two in water polo)
►► 15 dislocations or subluxations (four in wrestling, three in
judo, two in boxing)
►► 12 lesions of meniscus or cartilage
►► nine concussions (out of 12 in total: seven in boxing, two in
rugby, one each in BMX cycling, mountain bike cycling, and
handball)
►► seven stress fractures (three in athletics, two in tennis, one
each in boxing and triathlon)
►► six tendon ruptures
►► five contusions, haematomas or bruises
►► five lacerations, abrasions or other skin lesions (three in
boxing, two in triathlon)
►► four nerve or spinal cord injuries
►► four tendinopathies (three in athletics)
►► two arthritis, synovitis or bursitis injuries
►► two impingements
►► two 'other bone injuries
Injury type was missing for two of the severe injuries.

Figure 1 Proportions of athletes (%) in each sport with injury, injury

with estimated time loss ≥1 day, and injury with estimated time loss >7 There was no statistical difference in the incidence of injury
days. between the NOCs that did not report any NOC data (ie, Rio
2016 data only) and the NOCs that reported data (7.9 vs 9.8
injuries per 100 athletes; RR=1.24 (0.72–2.14)).
114 NOCs with >10 participating athletes (accounting for 10
772/96% of all the athletes) was 74% (1439 of 1938 forms). Severity of injuries
While almost two thirds of the injuries were estimated to result
in no time loss from sport (n=662, 60%), 40% of the injuries
Injuries overall, by sport and gender (n=438) were expected to prevent the athlete from participating
We recorded a total of 1101 injuries, equalling 9.8 injuries in competition or training (online appendix 3). Figure 1 shows
(95% CI 9.2 to 10.3) per 100 participating athletes. This corre- the incidence of injuries estimated to lead to ≥1 day and >7 days
sponds to 5.7 injuries per 1000 athlete-days. On average, 8% of absence in each sport. It was estimated that 14% of the inju-
(n=931) of the athletes sustained at least one injury. In addition, ries (n=153) would result in an absence from sports from 1 to 3
there were 70 and 10 athletes with two and three injuries each, days, 6% (n=64) in an absence from 4 to 7 days, 10% (n=106)
respectively. in an absence from 8 to 28 days and 10% (n=115) in an absence
Figure 1 shows the incidence proportion of injured athletes for more than 28 days. Information on severity was missing for
in each sport (additional details are available in online appendix one injury.
3). The incidence of injury was highest in BMX cycling (37.5 A total of 221 injuries (20%) were classified as severe, with
injuries (95% CI 20.2 to 54.8) per 100 athletes), boxing (30.1 an estimated absence from training or competition of more than
(23.7–36.4)), mountain bike cycling (23.8 (13.1–34.4)), 1 week (box 1, online appendix 3).
taekwondo (23.6 (15.2–32.1)), water polo (19.4 (14.0–24.8))
and rugby (18.6 (13.6–23.5)), and lowest in canoe slalom, Location and type of injuries
rowing, shooting, archery, swimming, golf and table tennis The most commonly injured anatomical locations were the knee
(ranging from 0 to 3 injuries per 100 athletes). (n=130), thigh (n=108), ankle (n=103), face (n=94) and lower
The injury incidences for women (9.3 injuries (95% CI 8.4 leg (n=90). The most common injury types were sprain/ligament
to 10.1) per 100 athletes) and men (9.4 (8.6–10.1), RR=0.99 rupture (n=187), contusion/haematoma/bruise (n=178), strain/
(0.87–1.11)) were nearly identical (online appendix 4). muscle rupture/tear (n=168), laceration/abrasion/skin lesion
However, women were at significantly higher risk of injury in (n=152) and tendinosis/tendinopathy (n=112). The distribu-
sailing (RR=5.33 (1.78–15.93)), shooting (RR=5.14 (1.67– tion of injury locations and injury types per sport is presented in
15.78)) and mountain bike cycling (RR=3.61 (1.37–9.50)). online appendices 5 and 6, respectively.

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Original article
Causes, mechanisms and onset of injury
While 71% (n=781) of the injuries were reported to occur
acutely, 27% (n=301) were reported to be caused by overuse
(information missing for 19 injuries). The three most commonly
reported injury causes/mechanisms were contact with another
athlete (28%), non-contact trauma (21%) and overuse with
gradual onset (19%). The distribution of injury causes/mech-
anisms in each sport is detailed in online appendix 7. Of all
overuse injuries (gradual and sudden onset) occurring in the
Games, 72% were recorded with no estimated absence from
competition or training.
In terms of onset, 59% of the injuries were sustained in compe-
tition (5.8 (5.3–6.2) injuries per 100 athletes) and 37% during
training (3.6 (3.2–3.9) injuries per 100 athletes; RR=1.61
(1.42–1.82)) (information on training/competition was missing
for 45 injuries; online appendix 3). However, when analysing
only the severe injuries, those estimated to result in at least 7 days
of absence, the difference was greater (RR=2.22 (1.69–2.96)).
Injuries in training and in competition differed significantly in
characteristics (location, type, mechanism and subsequent time
loss from sport) and in terms of incidence in different sports
(online appendix 3). The injury incidence was higher in compe-
tition than in training in boxing (RR=7.50 (3.88–14.51)), tennis
(RR=6.00 (1.77–20.37)), hockey (RR=5.71 (2.56–12.76)),
rugby (RR=5.38 (2.53–11.43)), handball (RR=3.90 (1.95–
7.81)), football (RR=3.63 (2.08–6.31)), water polo (RR=3.56
(1.70–7.45)), BMX cycling (RR=3.50 (1.15–10.63)), basketball
(RR=3.40 (1.25–9.22)), fencing (RR=3.25 (1.06–9.97)) and
judo (RR=2.91 (1.47–5.77)). Swimming was the only sport in
which the incidence of injury was significantly higher in training
than in competition (RR=0.29 (0.11–0.80)).

Illnesses overall, by gender, sport and severity Figure 2 Proportions of athletes (%) in each sport with illness, illness
Among the 11 289 exposed athletes, a total of 613 illnesses were with estimated time loss ≥1 day and illness with estimated time loss >7
reported, resulting in 5.4 illnesses (95% CI 5.0 to 5.9) per 100 days.
athletes. This corresponds to 3.2 illnesses per 1000 athlete-days.
On average, 5% (n=587) of the athletes incurred an illness, of the illnesses, 3% of the athletes incurred an infection). Of the
as there were 26 athletes with two illnesses each. Women (5.7 292 respiratory illnesses, 223 (76%) were caused by an infec-
illnesses (5.0–6.3) per 100 athletes) were at significantly higher tion. The distribution of affected systems, main symptoms and
risk of contracting an illness than men (4.0 (3.5–4.5), RR=1.41 causes of illness per sport are presented in online appendices 8,
(1.19–1.67)). 9 and 10, respectively.
Figure 2 shows the incidence proportion of ill athletes in
each sport (additional details are available in online appendix Data sources, and injuries and illnesses per NOC size
3). Diving was the sport with the highest illness incidence Only 6% of the injuries and 2% of the illnesses were captured by
(11.9 illnesses (95% CI 6.0 to 17.7) per 100 athletes), followed both the NOCs and the Rio 2016 staff. While 59% of the inju-
by open-water marathon (11.8 (2.4–21.2)), sailing (11.8 ries and 70% of the illnesses were recorded solely by the NOCs,
(8.4–15.3)), canoe slalom (10.8 (3.8–17.9)), equestrian (10.5 27% and 15% of the injuries and illnesses, respectively, were
(6.0–15.0)) and synchronised swimming (9.6 (3.7–15.6)). The recorded only by the Rio 2016 staff.
illness incidence was low in a number of sports, with the lowest Whereas the majority of injured and ill athletes from the larger
incidences recorded in trampoline and artistic gymnastics, golf NOCs were seen internally by the NOC medical staff, athletes
and handball (ranging from 0 to 2 illnesses per 100 athletes). from small NOCs were to a greater extent relying on diagnosis
One in five illnesses (n=113, 18%) were expected to result and treatment from the Rio 2016 medical staff (table 1).
in absence from training or competition. Of these, two illnesses There was also an inverse relationship between NOC size
(0.3%) were expected to result in an estimated time loss of more (measured in number of participating athletes) and the risk inju-
than 7 days (chickenpox and conjunctivitis). ries, with athletes from smaller NOCs suffering more injuries
(NOCs with <10 athletes: 12.2 (9.1–15.2) injuries per 100
Affected system, main symptoms and causes of illness athletes versus NOCs with >99 athletes: 8.7 (8.1–9.4) injuries
A total of 292 illnesses (47%) affected the respiratory system. The per 100 athletes, injury RR=1.40 (1.07–1.81)).
second, third and fourth most frequently affected systems were
the digestive system (n=131, 21%, 1% of the athletes affected), Discussion
skin and subcutaneous tissue (n=53, 9%), nervous system The aim of the present paper was to describe and analyse the
(n=38, 6%) and genitourinary system (n=27, 4%), respectively. incidence and characteristics of the sports injuries and illnesses
Infection was the most common cause of illness (n=346, 56% in the Rio 2016 Olympic Games. The main findings of this

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Original article
17-day-long prospective cohort study were that 8% and 5% of athletes’ exposure to risk, an observation that emphasises the
of all the 11 274 athletes suffered from at least one injury or value of ongoing surveillance to monitor trends over time, for
illness, with overall incidences of 9.8 injuries and 5.4 illnesses example, the effect of venue design, rule or equipment changes
per 100 athletes, respectively. The magnitude and characteristics in the period between major sports events.
of the injuries and illnesses varied substantially between sports
and gender. Severity of injuries
Injury incidences varied from high to low across sports, with In major sports events, like the Olympic Games, injuries or
the highest incidences found in BMX cycling, boxing, mountain illnesses of even minor severity with or without time loss have
bike cycling, taekwondo, water polo and rugby. Illness inci- the potential to be both participation limiting and perfor-
dences were generally lower, with the highest incidences seen in mance inhibiting, and thus prevent athletes from possibly
diving, open-water marathon, sailing, canoe slalom, equestrian fulfilling their potential and reaching their life-time achieve-
and synchronised swimming. ment. In the Rio Games, 40% of the injuries were estimated
to result in time loss from competition or training of at least
1 day. This places Rio 2016 between London 2012 and Beijing
Injuries in the Olympic sports 2008, in which the equivalent numbers were 35% and 50%,
The incidence of injury in the Rio Games (8%) was lower than respectively. In contrast, athletes in Rio incurred more injuries
those in Beijing 2008 (10%),78 Vancouver 2010 (11%),79 London of higher severity (20% of the injuries estimated to result in
2012 (11%)80 and Sochi 2014 (12%).81 It was also lower than the absence greater than 7 days) than the athletes in London 2012
injury incidences reported from recent Paralympic Games.33–36 38 and Beijing 2008 (both 13%).
When comparing each sport in Rio 2016 with Beijing 2008, The sports with the highest incidences of injuries entailing a
higher injury incidences were found in diving (9% vs 2% of the prolonged absence from training or competition (>7 days) were
athletes injured), water polo (19% vs 10%), boxing (30% vs BMX cycling (10% of the athletes), wrestling (5%), weightlifting
15%), fencing (8% vs 2%) and sailing (6% vs 1%), while the (5%) and triathlon (5%), which is similar to the data from the
injury incidences were lower in basketball (8% vs 13%), football London Games.
(15% vs 32%) and hockey (12% vs 20%).
Likewise, when doing a similar comparison with London
2012, the injury incidences in Rio were higher in boxing (30% Causes, mechanisms and onset of injury
vs 9%) but lower in athletics (11% vs 18%), football (15% vs The causes, mechanisms and circumstances of injuries in compe-
35%), handball (15% vs 22%), sailing (6% vs 15%), swimming tition and training differed significantly between the different
(3% vs 5%) and taekwondo (24% vs 39%). sports. Overall, the distribution of injuries in competition and
Some sports have collected and published data on injury inci- training (59% vs 37%) was similar to that of London 2012,80
dences in their world championships or other main events. The the 2009 and 2013 Aquatics World Championships,46 47 the
incidence of football injury in Rio 2016 was similar to those in 2010 men's Football World Cup,19 and the 2011 Athletics World
the 2014 World Cup,20 200429 and 200831 European champi- Championships,42 but not Beijing 2008,78 the 2007 or 2009
onships, but half of that in the 2010 World Cup.19 In athletics, Athletics World Championships,40 41 or the 2015 men's Handball
as well as in diving, swimming and synchronised swimming, the World Championships,64 where the incidence of competition
injury incidences in Rio were similar to those reported from injuries was higher. In Rio 2016, the majority of injuries were
recent world championships.40–47 In contrast, the Rio injury inci- reported to be acute, whereas overuse injuries with either a
dences in open-water marathon and water polo were lower and gradual or sudden onset accounted for a quarter of the injuries.
higher, respectively, than previously reported from the aquatics Although similar distributions were reported from London 2012
world championships.46 47 In rugby sevens, the injury incidence and Beijing 2008, these numbers should be interpreted with
in Rio was less than half than previously found in the Rugby caution, due to the limitations in the recording of overuse inju-
Sevens World Cup and World Series.23 Similarly, the proportions ries in the current methodology.82–86
of injured athletes in the beach volleyball tournaments in the
three latest summer Olympic Games constitute about one third Illness risk during the Olympics
of that reported earlier in the beach volleyball world champion- In the lead up to the Rio Games, there were concerns about
ships.14 In handball, the incidence of injuries in Rio was about the risk of gastroenteritis and other infections from various
half of that found in the men's world championship in 2015.64 water-borne viruses and bacteria, as well as the mosquito-borne
Interestingly, and in contrast, the BMX cycling injury incidence Zika virus, with some calling for the Games to be cancelled.87
in Rio was about six times higher than that documented in the However, the overall proportion of athletes with illness in the
1989 BMX European championships.70 Rio Games (5%) was actually lower than those reported from
A change in injury incidence can be the result of changes in the London 2012 (7%),80 Vancouver 2010 (7%)79 and Sochi 2014
composition of the Olympic Games programme (eg, two new (8%).81 While the majority of illnesses in Rio (56%) were caused
sports in Rio), environmental factors, venue or track design, by an infection, the proportion of athletes contracting an infec-
competition rules or changes in equipment. Recorded injury tion (3%) was identical to London 2012 (3%) and lower than
frequencies are also likely to be influenced by the response rate Sochi 2014 (5%). Similarly, the incidence of digestive system
and reporting accuracy by the NOC and organising committee illness (1%) was identical to London 2012 (also 1%). In terms
medical staff. However, our analysis comparing the injury inci- of the Zika virus, no cases were reported among either athletes
dences of the NOCs that reported data and those that did not or the general population during the Olympic Games in Rio.88
(other than the data recorded by the Rio 2016 staff) indicated no As in previous Olympic Games,79–81 female athletes contracted
significant difference between the two. In addition, in Rio 2016, more illnesses than male athletes. The same disproportion has
a new electronic medical record was used for the first time by the previously been reported in the 2009 Athletics41 and Aquatics46
organising committee medical staff. Also, incidence differences World Championships, but not in the 2011 Athletics42 or 2013
(lower or higher) may simply be the result of a natural variability Aquatics47 World Championships, in the 1994–2009 US Open

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Original article
Tennis Championships,89 or in the Winter or Summer Paralympic for tailoring preventive measures to the specific context of each
Games.37 39 sport. Sport bodies such as the IOC, International Paralympic
Committee, International Sports Federations (IFs) and NOCs
have the responsibility to protect the health of their athletes. The
Methodological considerations
Olympic Movement Medical Code encourages all stakeholders
In studies on sports injury, it is usually recommended to express
to take measures to ensure that sport is practised with minimal
incidences using a measure of time exposed to risk as the denom-
risks of physical injury and illness or psychological harm.94 For
inator.35–37 90 91 However, considering the inherent complexity
IFs, a critical component of this responsibility is the implementa-
and size of the Olympic Games, this was not feasible in the
tion of a scientifically sound injury and illness surveillance system
present study. Instead, we expressed the injuries or illnesses
in all major events. Some sports federations have put increasing
by means of absolute risk: the number of new cases per 100
effort into working systematically and scientifically to protect
registered athletes (incidence proportion). This approach erro-
their athletes’ health.15–20 22–47 49–61 68 We encourage other IFs
neously assumes that the frequencies and lengths of exposure
and sports organisations to follow their example.
are identical in all sports and that the number of athletes at risk
in each NOC is constant throughout the Games. Interpretation
of differences in injury incidences or patterns should therefore Conclusion
be made with caution. In summary, 8% of the athletes had a reported medical encounter
In the current study, we defined injuries and illnesses as new for a new or recurrent injury and 5% an illness during the Rio
or recurring injuries or illnesses receiving medical attention, Olympic Summer Games. The incidences and characteristics of
regardless of the consequences with respect to absence from injuries and illnesses in training and competition varied substan-
competition or training. By using such a definition, predomi- tially between sports and gender.
nantly the moderate and severe acute injuries will be recorded.
The less serious injuries may be overlooked, since such injuries What are the findings?
do not always require medical attention,92 93albeit our results
show that the majority of reported injuries were not estimated ►► Overall, 8% and 5% of the athletes incurred at least one
to involve any absence from the sport. In the Olympic Games, all injury or illness, respectively, during the Rio 2016 Olympic
athletes can get healthcare through the athletes’ village polyclinic Games.
and the venue medical clinics. However, the availability, size and ►► BMX cycling (38%), boxing (30%), mountain bike cycling
quality of the NOCs’ own medical teams vary among countries, (24%), taekwondo (24%), water polo (19%) and rugby
meaning that not all athletes benefit from identical healthcare, (19%) were the sports with the highest incidence of injury.
which may bias the injury and illness recording. ►► Diving (12%), open-water marathon (12%), sailing (12%),
Throughout the 17 days of data collection in the Olympic canoe slalom (11%), equestrian (11%) and synchronised
Games, we collected 45% of all the NOC injury and illness swimming (10%) were the sports with the highest
report forms. If including only the NOCs which we actively illness incidence.
followed up (those with more than 10 athletes), as done in ►► The rate of infectious diseases in Rio was low and consistent
previous Olympic Games, the response rate was 74%, which is with previous Olympic Games.
lower than in previous Games (99.7% in Sochi; 96% in London).
It is difficult to speculate as to what the potential causes are. In
the future, transitioning to an electronic data collection system, How might it impact on clinical practice in the near
similar to that used in the Paralympics,35 may help to improve future?
the response rate among the NOCs, as well as the accuracy of
the data. ►► These injury and illness data can help inform policy and
A mere 6% of the injuries and 2% of the illnesses were planning of major multi-sport events (eg, Asian Games,
captured by both the NOC and the Rio 2016 medical personnel, Commonwealth Games, Pan American Games, European
underlining the importance of both recorder groups. Our study Games).
also shows that in particular athletes from smaller NOCs benefit ►► These data can directly inform the focus and development of
from diagnosis and treatment from the local organising commit- injury prevention measures in sport
tee’s medical staff, whereas the majority of athletes from larger
NOCs are seen by their own NOC medical staff. More impor- Author affiliations
1
tantly, we once again identified an inverse relationship between Medical and Scientific Department, International Olympic Committee, Lausanne,
Switzerland
NOC size and the risk of health problems, with athletes from 2
Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta,
the smallest NOCs experiencing significantly more injuries Canada
compared with the largest NOCs. It is difficult not to see this 3
Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo Sports
finding in light of distinct differences in resources available Trauma Research Center, Oslo, Norway
4
to the NOC. Large delegations usually come from countries School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
5
Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine,
with well-developed exercise physiology and sports medicine University of Nottingham, Nottingham, UK
communities and are generally able to offer their athletes more 6
Department of Sports Medicine, Aspetar Qatar Orthopedics and Sports Medicine
comprehensive healthcare and closer medical follow-up both in Hospital, Doha, Qatar
7
the lead up to and during the Games, potentially giving them a Department of Physical Therapy, University of Massachusetts Lowell, Lowell,
Massachusetts, USA
competitive advantage. 8
Department of Neurology, Spine Unit, Schulthess Clinic, Zurich, Switzerland
9
Institute of Sport and Health, University College Dublin, Dublin, Ireland
10
Fédération International de Natation (FINA), Lausanne, Switzerland
Practical implications 11
Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São
The continuously accumulating evidence that injuries and Paulo, São Paulo, Brazil
illnesses vary substantially between sports demonstrates the need 12
GE Healthcare, Moscow, Russia

6 Soligard T, et al. Br J Sports Med 2017;0:1–8. doi:10.1136/bjsports-2017-097956

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Original article
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8 Soligard T, et al. Br J Sports Med 2017;0:1–8. doi:10.1136/bjsports-2017-097956

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Sports injury and illness incidence in the Rio

de Janeiro 2016 Olympic Summer Games: A
prospective study of 11 274 athletes from 207
countries
Torbjørn Soligard, Kathrin Steffen, Debbie Palmer, Juan Manuel Alonso,
Roald Bahr, Alexandre Dias Lopes, Jiri Dvorak, Marie-Elaine Grant,
Willem Meeuwisse, Margo Mountjoy, Leonardo Oliveira Pena Costa,
Natalia Salmina, Richard Budgett and Lars Engebretsen

Br J Sports Med published online July 29, 2017

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