The American Journal of Sports

Medicine http://ajs.sagepub.com/

Sports Injuries During the Summer Olympic Games 2008

Astrid Junge, Lars Engebretsen, Margo L. Mountjoy, Juan Manuel Alonso, Per A. F. H. Renström, Mark John Aubry and
Jiri Dvorak
Am J Sports Med 2009 37: 2165 originally published online September 25, 2009
DOI: 10.1177/0363546509339357

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Sports Injuries During the Summer
Olympic Games 2008
Astrid Junge,*† PhD, Lars Engebretsen,‡§ MD, PhD, Margo L. Mountjoy,‡|| MD,
¶ ‡# a
Juan Manuel Alonso, MD, Per A. F. H. Renström, MD, PhD, Mark John Aubry, MD,
b
and Jiri Dvorak MD, PhD
†
From the FIFA Medical Assessment and Research Centre (F-MARC) and Schulthess Klinik,
‡
Zurich, Switzerland, International Olympic Committee (IOC) Medical Commission,
§
Lausanne, Switzerland, Oslo Sports Trauma Research Centre (OSTRC) and
Ullevaal University Hospital and Medical School, University of Oslo, Oslo, Norway,
||
Fédération International de Natation (FINA), Lausanne, Switzerland, ¶International
#
Association of Athletics Federations (IAAF), Monaco, Karolinska Institute, Stockholm,
a
Sweden, International Ice Hockey Federation (IIHF), Zurich, Switzerland, and
b
Fédération Internationale de Football Association (FIFA), Zurich, Switzerland

Background: Standardized assessment of sports injuries provides important epidemiological information and also directions for
injury prevention.
Purpose: To analyze the frequency, characteristics, and causes of injuries incurred during the Summer Olympic Games 2008.
Study Design: Descriptive epidemiology study.
Methods: The chief physicians and/or chief medical officers of the national teams were asked to report daily all injuries newly
incurred during the Olympic Games on a standardized injury report form. In addition, injuries were reported daily by the physi-
cians at the medical stations at the different Olympic venues and at the polyclinic in the Olympic Village.
Results: Physicians and/or therapists of 92 national teams covering 88% of the 10 977 registered athletes took part in the study.
In total, 1055 injuries were reported, resulting in an incidence of 96.1 injuries per 1000 registered athletes. Half of the injuries
(49.6%) were expected to prevent the athlete from participating in competition or training. The most prevalent diagnoses were
ankle sprains and thigh strains. The majority (72.5%) of injuries were incurred in competition. One third of the injuries were
caused by contact with another athlete, followed by overuse (22%) and noncontact incidences (20%). Injuries were reported from
all sports, but their incidence and characteristics varied substantially. In relation to the number of registered athletes, the risk of
incurring an injury was highest in soccer, taekwondo, hockey, handball, weightlifting, and boxing (all ≥15% of the athletes) and
lowest for sailing, canoeing/kayaking, rowing, synchronized swimming, diving, fencing, and swimming.
Conclusion: The data indicate that the injury surveillance system covered almost all of the participating athletes, and the results
highlight areas of high risk for sport injury such as the in-competition period, the ankle and thigh, and specific sports. The iden-
tification of these factors should stimulate future research and subsequent policy change to prevent injury in elite athletes.
Keywords: injury surveillance; multisport event; top-level athletes; championships

The Olympic Games are the largest world sport event with health and the prevention of injuries. As has been shown
over 10 000 participating athletes from more than 200 previously,12,18 standardized assessment of sports injuries
countries. The International Olympic Committee (IOC) is provides not only important epidemiological information
increasingly emphasizing the protection of the athletes’ but also directions for injury prevention and the opportu-
nity for monitoring long-term changes in the frequency
*
Address correspondence to Astrid Junge, Schulthess Klinik, Lengghalde 2, and circumstances of injury. As part of a long-term sports
CH-8008 Zurich, Switzerland (e-mail: [email protected]). injury prevention project, the IOC decided to conduct an
No potential conflict of interest declared. injury surveillance study during the Olympic Games 2008
in Beijing.
The American Journal of Sports Medicine, Vol. 37, No. 11
DOI: 10.1177/0363546509339357 Injury surveillance studies have been performed in sev-
© 2009 The Author(s) eral single-sport tournaments, such as soccer,9,10,17-19,36,39

2165
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2166 Junge et al The American Journal of Sports Medicine

rugby,6,13,16,22,38 karate,3,30,31 ice hockey,33,34 volleyball,35 Injury Report Form

beach volleyball,5 handball,25 tennis,15 cycling,7 and ath-
letics.1 For multisport events, however, only 8 studies were The injury report form20 required documentation of the fol-
found in the literature, including 3 on disabled lowing information: athlete’s accreditation number, sport/
athletes.28,32,37 Sports injuries were surveyed at the 1985 discipline, round/heat/training, date and time of injury,
Junior Olympics (13 sports),27 the 1994 Star of the North injured body part, type and cause of injury, and estimated
Summer Games (21 sports),26 the 1994 Australian Univer­ duration of the subsequent absence from competition and/
sity Games (19 sports),8 the Badger States Summer Games or training. Definitions of these parameters were stated on
1994-1996 (10 sports), 14 and the 2004 Olympic Games the back of the form. The injury report form was available
(8 sports).21 in 7 languages (English, French, Chinese, Spanish, German,
During the 2004 Olympic Games,21 the incidence and Russian, and Arabic). The English version is published
characteristics of injuries in all team sport tournaments elsewhere.20
(soccer, handball, basketball, field hockey, baseball, soft-
ball, water polo, and volleyball) were recorded using an Confidentiality and Ethical Approval
injury surveillance system established in soccer9,12,17-19,39
and handball.25 Because the compliance with the proce- The athletes’ accreditation number was only used to avoid
dure was excellent and the quality of the data obtained duplicate reporting from NOC and LOC physicians and to
high,21 the injury surveillance system was modified to be provide information on age, gender, sport, and national
applicable for both individual and team sports.20 The IOC federation of the athlete from the IOC database. All infor-
injury surveillance system proved feasible and useful for mation was treated strictly confidential, and the injury
individual sports in a pilot study during the 11th World reports were made anonymous after the Olympic Games.
Championship in Athletics.1 Ethical approval was obtained from the Oslo University
The aim of the present study was to analyze the fre- School of Medicine Ethical Committee.
quency, characteristics, and causes of injuries incurred in
competitions and/or training during the Olympic Games Implementation and Data Collection
2008 in Beijing.
Three months before the 2008 Olympic Games, the NOCs
were informed about the study by the IOC. The medical
METHODS representatives of all participating NOCs received a book-
let with detailed information on the study 1 month before
A detailed description of the applied methodology has been the Games and were requested to participate in the project.
published by the Beijing Olympics Study Group.20 In sum- All NOC physicians and therapists and the chairpersons of
mary, the physicians and/or chief medical officers of the the Medical Commissions of the Summer Olympic Inter­
National Olympic Committees (NOCs) were asked to national Sports Federations were invited to an instruc-
report daily all newly incurred injuries (or the nonoccur- tional meeting 2 days before the opening of the Games in
rence of injuries) on a standardized injury report form. Beijing. During this meeting, the NOC physicians were
Injuries were additionally reported by the Local Organizing informed about the background and aims of the study and
Committee (LOC) physicians at the medical stations at the instructed on the completion and return of the injury
different Olympic venues and at the polyclinic in the report form by the study group. Questions of the partici-
Olympic Village. pants were answered, and the instructional booklet and
the injury report forms were distributed. During the
Definition of Injury Olympic Games, members of the study group met on sev-
eral occasions with or telephoned the physicians of NOCs
An injury was defined as any musculoskeletal complaint with more than 50 athletes to motivate daily compliance
(traumatic and overuse) newly incurred due to competition with form submission.
and/or training during the XXIXth Olympiad in Beijing that The NOC chief physician was responsible for reporting
received medical attention regardless of the consequences the injuries of their athletes. One NOC did not report the
with respect to absence from competition or training.20 This injuries in a specific sport; another NOC reported only
injury definition includes 5 aspects: (1) all injuries that injuries in 2 sports. For soccer, the collection of the forms
received medical attention (not only time loss injuries), (2) was slightly different because the matches started before
newly incurred injuries (pre-existing, not fully rehabilitated the official opening, most venues were not in Beijing, and
injuries should not be reported) and reinjuries (injuries of all soccer teams had their own physicians. Following the
the same location and type should be reported only if the established procedure in FIFA competitions,9,12,17-19 the
athlete has returned to full participation after the previous forms were collected after each match by the FIFA Medical
injury), (3) in-competition and training injuries, (4) during Officer at the venue and returned to the IOC study office.
the Olympic Games (August 9-24, 2008, except soccer; for To also receive information about injured athletes of
details, see “Implementation”), and (5) exclusion of illnesses NOCs that did not have a team physician or therapist,
and diseases. If multiple body parts were injured or multiple injury reports were additionally collected from the medi-
types of injury in the same body part were incurred in one cal stations at the 38 different Olympic venues and the
incident, this is counted as one injury with 2 diagnoses.20 polyclinic in the Olympic Village. Medical stations at the

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Vol. 37, No. 11, 2009 Sports Injuries During the Summer Olympic Games 2008 2167

TABLE 1
Response Rate and Number of Injuries in Relation to Size of the National Teama

Size of NOC
(No. of Athletes)

>200 100-200 50-99 25-49 10-24 <10 Total

NOCs, n 16 13 26 23 30 96 204
Athletes, n 5679 1811 1821 763 452 451 10 977
NOCs with participating physician(s),b n (%) 16 13 24 13 8 18 92
(100) (100) (92.3) (56.5) (26.7) (18.8) (45.1)
Forms returned by NOC physicians,c n (%) 208 169 301 141 56 174 1050
(81.3) (81.3) (78.4) (67.8) (43.8) (60.4) (72.1)
Injuries reported by NOC physicians, n 405 147 153 39 25 18 787
Injuries reported only by venue or polyclinic,d,e n 49 20 49 41 31 68 268
Injuries reported by NOC physicians,e % 89.2 88.0   75.7   48.8   44.6   20.9 74.6
Total injuries,e n 454 167 202 80 56 86 1055
Injuries per 1000 registered athletes,e n 79.9 92.2 110.9 104.8 123.9 190.7 96.1
a
NOC, National Olympic Committee.
b
NOCs of which the team physician returned at least 1 injury report form.
c
Except soccer (for soccer, an additional 264 of 294 [89.9%] forms were returned).
d
Injuries reported also by NOC physicians are not included.
e
Country is missing in 10 cases.

venues were requested to report on a slightly modified All data were processed using Excel (Microsoft, Redmond,
injury report form (additional information on the NOC of Washington) and SPSS (Chicago, Illinois). Statistical meth-
the injured athlete) on all days a competition took place ods applied were descriptive statistics, frequencies, cross-
in the respective venue. During the Games, a member of tabulations, t test, and χ2 test. Significance was accepted at
the study group visited the medical stations at the differ- P < .05.
ent venues in Beijing to instruct them on accurate com-
pletion of the forms and to motivate daily compliance of
submission. Venues outside Beijing (soccer, sailing, eques- RESULTS
trian) were contacted via e-mail and telephone. Daily injury
information was also received from the polyclinic in the Response Rate and Coverage of Athletes
Olympic Village. However, this information was extracted
from the local database and included only the accreditation The physicians or responsible therapists of 92 national
number of the athlete and the location and type of injury. teams with 9672 (88%) athletes took part in the study
Thus, information on the circumstance (competition/train- and returned a total 1314 injury report forms. In addi-
ing) and cause of injury and resulting time loss in sport tion, 264 injury report forms from medical stations at the
was missing for these injuries. In case of duplicate report- different Olympic venues and all daily reports from the
ing, information from the NOC physician was preferred to polyclinic in the Olympic Village were received.
the LOC physician’s report, and information from the The coverage of athletes by NOC physicians corre-
venue and polyclinics was summarized. sponded closely to the amount of injuries they reported (for
details, see Table 1). Overall, 787 (74.6%) injuries were
reported by the NOC physicians, 16 by medical representa-
Data Analysis tives of the international sport federation at the venue,
127 injuries from medical stations at the venues, and
The IOC provided a list of athletes registered for the 2008
234 from the polyclinic (109 injuries by more than one
Olympic Games; the competition schedule was available on
source of information). The percentage of injuries reported
the Internet (http://en.beijing2008.cn). The response rate of
by NOC physicians decreased with the size of the national
the NOC physicians was determined by dividing the number
team because small teams often do not include a physician.
of received forms by the number of expected forms (number
of NOCs that returned at least one injury report form mul-
tiplied with 16 days). The coverage of athletes and of inju- Frequency and Diagnosis of Injuries
ries was assessed regarding the number of athletes in the
respective NOC in the analysis and comparing the propor- A total of 1055 injuries were reported, equivalent to an
tion of injuries reported by NOC physicians and other incidence of 96.1 injuries per 1000 registered athletes.
sources for NOCs of different sizes. The different mode of Because 46 injuries had multiple locations or types, 1108
data collection in soccer and the reduced number of athletes diagnoses were named (for details, see online appendix for
reported on in 2 NOCs were regarded in these calculations. this article at http://ajs.sagepub.com/supplemental/). The

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2168 Junge et al The American Journal of Sports Medicine

TABLE 2
Athletes and Injuries in Different Sports

Estimated Athletes
Registered Total Injuries, n With Time Injuries in Injuries in
Sports Athletes, n (% of Athletes) Loss Injuries, % Training,a n (%) Competition,a n (%)

Archery 128 9 (7.0) 2.3 6 (100) 0

Athletics 2132 241 (11.3) 7.3 69 (42.6) 93 (57.4)
Baseball 189 21 (11.1) 5.6 2 (10.5) 17 (89.5)
Badminton 172 8 (4.7) 3.1 1 (14.3) 6 (85.7)
Basketball 287 38 (13.2) 4.1 6 (19.4) 25 (80.6)
Beach volleyball 96 8 (8.3) 2.1 4 (50.0) 4 (50.0)
Boxing 281 42 (14.9) 8.1 2 (5.3) 36 (94.7)
Canoeing/kayaking 324 4 (1.2) 0.6 4 (100) 0
Cycling 518 30 (5.8) 2.0 10 (33.0) 20 (66.7)
Diving 145 3 (2.1) 0 3 (100) 0
Equestrian 193 10 (5.2) 1.0 5 (50.0) 5 (50.0)
Football 496 156 (31.5) 16.4 28 (18.2) 126 (81.8)
Fencing 206 5 (2.4) 0.8 0 2 (100)
Gymnastics 318 24 (7.5) 2.5 11 (52.4) 10 (47.6)
Handball 334 58 (17.4) 13.4 4 (7.4) 50 (92.6)
Hockey 382 78 (20.4) 3.5 5 (6.9) 67 (93.1)
Judo 385 53 (11.2) 6.4 5 (11.6) 38 (88.4)
Modern pentathlon 71 4 (5.6) 4.2 2 (50.0) 2 (50.0)
Rowing 548 10 (1.8) 0.6 1 (16.7) 5 (83.3)
Sailing 400 3 (0.8) 0 1 (33.3) 2 (66.7)
Shooting 386 3 (7.8) 3.9 2 (100) 0
Softball 119 16 (13.4) 1.9 2 (14.3) 12 (85.7)
Swimming 1046 36 (3.4) 1.0 15 (62.5) 8 (34.8)
Synchronized swimming 104 2 (1.9) 0 2 (100) 0
Tennis 168 10 (5.9) 3.0 5 (62.5) 3 (37.5)
Taekwondo 126 34 (27.0) 16.2 9 (36.0) 16 (64.0)
Triathlon 109 10 (9.2) 8.0 3 (33.3) 6 (66.7)
Table tennis 172 9 (5.2) 2.6 5 (83.3) 1 (16.7)
Volleyball 287 23 (8.0) 3.6 4 (18.4) 18 (81.8)
Weightlifting 255 43 (16.9) 11.4 3 (10.3) 26 (89.7)
Water polo 259 25 (9.7) 3.7 2 (9.5) 19 (90.5)
Wrestling 341 32 (9.4) 6.1 4 (20.0) 16 (80.0)
b
Total 10 977 1048 (9.6) 4.7 225a (26.2) 633a (73.8)
a
Information is missing for 197 injuries.
b
Sport is missing for 7 injuries.

most prevalent diagnoses were ankle sprains (n = 81; 7.3%) cause, and subsequent time loss from sport) and with
and thigh strain (n = 75; 6.8%). About half of the diagnoses regard to the different sports (for details, see Table 2).
(n = 600; 54.2%) affected the lower extremity, upper One third of the injuries (n = 282; 32.9%) were caused
extremity (n = 218; 19.7%), trunk (n = 149; 13.4%), and by contact with another athlete. Noncontact trauma (n =
head/neck (n = 133; 12.0%). The thigh (13.3%) and knee 172; 20.0%) and overuse either with gradual (n = 78; 9.1%)
(12.1%) were most commonly injured, followed by the or sudden onset (n = 110; 12.8%) were also frequent causes
lower leg and ankle. Head injuries (9.4%) were also fre- of injury. Some injuries were due to contact with an object
quent, mainly diagnosed as skin lesions or contusions. (n = 115; 13.4%) and recurrence of previous injury (n = 47;
5.5%). Other potential causes of injury (playing field condi-
Circumstances and Causes of Injury tions [n = 15], weather conditions [n = 8], equipment failure
[n = 5], and others [n = 18]) were rarely stated.
Information on circumstance and cause of injury was
available for 858 (81.3%) injuries. The majority of inju- Time Loss From Sport After Injury
ries (n = 623; 72.6%) were incurred in competition, 10
during warm-up for competition, and 225 (26.2%) during Information in relation to time loss from sport after injury
training. The injuries incurred during warm-up before was available for 844 (80%) injuries. About half of the inju-
competition were analyzed as injuries during competi- ries (n = 419; 49.6%) were expected to prevent the athlete
tion. Injuries in training and in competition differed from participating in competition or training. Physicians
significantly in all injury characteristics (location, type, estimated that 275 (33.0%) injuries would result in an

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Vol. 37, No. 11, 2009 Sports Injuries During the Summer Olympic Games 2008 2169

absence from sports up to 1 week, 93 (11.2%) in an absence t­ aekwondo athletes, 8 (2.1%) judoka athletes, 5 (2.0%)
for more than a week but less than a month, and 41 (4.9%) weightlifters, 5 (1.5%) wrestlers, 7 (0.3%) track and field
for more than 28 days’ absence. In 10 cases, the duration of athletes, 2 BMX and 1 mountain bike cyclists, a boxer, a
absence was not specified. diver, a fencer, a triathlon athlete, 7 (2.1%) handball play-
The 41 injuries with an estimated time loss of more than ers, 4 (1.4%) basketball players, 5 (1.3%) hockey players, 3
4 weeks comprised 13 fractures (foot [n = 4], clavicle [n = 3], (0.6%) football players, 2 volleyball players, a baseball
knee [n = 2], arm, wrist, hand, and pelvis), 8 ligament rup- player, a badminton player, a beach volleyball player, a
tures (knee [n = 6], ankle [n = 2]), 5 dislocations (shoulder table tennis player, and a water polo player. Concussions
[n = 2], knee, elbow, and wrist), 3 ruptures of Achilles ten- were reported from boxing (n = 2; 0.7%), football (n = 3;
don, 3 sprains (ankle, knee, and shoulder), 6 muscle inju- 0.6%), baseball, basketball, hockey, judo, taekwondo, road
ries (thigh [n = 4], hip, and lower leg), 2 complex lesions of cycling, and slalom canoeing/kayaking (each n = 1).
the joints (shoulder, knee), and 1 concussion. Out of the 221
injuries for which information about time loss was not Age and Gender of Injured Athletes
specified, at least a further 22 were suspected to be severe
based on the type of injury (10 fractures, 8 ligament rup- The age of the injured athletes ranged between 15 and
tures, 4 complex injuries with ligament ruptures). 53 years with no significant difference between men and
women (mean, 25.7; SD, 4.75; missing: 122). In 549 (54.2%)
Injuries in Different Sports cases, the gender of the injured athlete was male and in
464 (45.8%) female (missing: 42). These characteristics
Injuries were reported from all sports (for details, see were similar to the age (mean, 25.9; SD, 5.48) and gender
Table 2). In relation to the number of registered athletes, distribution of all registered athletes (male, 57.6%; female,
the risk of incurring an injury was highest in soccer, tae­ 42.4%).
kwondo, field hockey, handball, weightlifting, and boxing
and lowest for sailing, canoeing/kayaking, rowing, synchro-
nized swimming, diving, fencing, and swimming. DISCUSSION
For most sports, injuries in training and competition
were reported but in substantially different proportions. No This study aimed to analyze all sports injuries of athletes
in-competition injury was reported from archery, canoeing/ participating in the Olympic Games 2008. To the authors’
kayaking, diving, shooting, and synchronized swimming. knowledge, this is the first survey on injuries during the
Although the incidence of injuries in these sports was low, Olympic Games including all sports.
it is interesting to note that training injuries were reported. The injury surveillance system20 was accepted by the
The proportion of training injuries was high in table tennis, NOC and the LOC medical personnel and is feasible in a
tennis, swimming, gymnastics, beach volleyball, equestrian, large multisport event. The data indicate that the injury
modern pentathlon, and athletics. A high percentage of surveillance system covered almost all participating ath-
competition injuries were incurred in boxing, water polo, letes. The NOC physicians and/or therapists of 92 national
hockey, handball, weightlifting, baseball, and judo. teams covering 88% of the registered athletes took part in
The causes of injury differed between the sports. Overuse the study. The NOCs with more than 50 athletes returned
was a frequent cause (>40% of the injuries) in rowing, mod- 80% of the daily injury report forms. For NOCs with fewer
ern pentathlon, sailing, shooting, tennis, beach volleyball, than 50 athletes, the response rate was lower because some
triathlon, athletics, weightlifting, swimming, and bad- reported only if an athlete was injured and did not submit
minton. Contact with another athlete was the cause of the daily report when no injury had occurred. In addition to
more than 50% of the injuries in boxing, judo, water polo, the injury reports from the NOCs, daily reports were
handball, taekwondo, wrestling, and football. In baseball received from the medical stations at the Olympic venues
and hockey, contact with a moving object (ball, stick) was and the polyclinic in the Olympic Village. The percentage of
the cause in more than half of the injuries. A noncontact injuries reported from the venues and the polyclinic
trauma was frequently incurred by cyclists, riders, shoot- increased for NOCs with fewer athletes because small
ers, tennis players, and volleyball players. NOCs often do not have medical personnel. The total rate
Time loss injuries were reported from all sports except of injuries increased from large NOCs to smaller NOCs,
flat-water canoeing, diving, sailing, and synchronized probably for the same reason. It is assumed that due to the
swimming. The risk of incurring a time loss injury was lack of medical care in smaller teams, the athletes had
highest in soccer, taekwondo, handball, weightlifting, box- more injuries and/or consulted the medical facilities offered
ing, triathlon, and athletics (Table 2). during the Olympics also for pre-existing injuries. However,
The fractures were incurred by 6 (4.8%) taekwondo ath- because athletes from NOCs with fewer than 10 athletes
letes, 5 (1.8%) boxers, 10 (0.5%) track and field athletes, 2 represented less than 5% of the total population, this bias
track cyclists, 2 gymnasts, 2 judoka athletes, 2 triathlon may be neglected. On the other hand, some participating
athletes, 1 rider, 1 synchronized swimmer, 1 wrestler, 6 NOCs and some medical stations at the Olympic venues did
(1.2%) football players, 4 (3.0%) handball players, 2 hockey not return forms on all days. Thus, it is estimated that the
players, 2 water polo players, 2 volleyball players, 1 softball injury incidence is slightly higher than reported.
player, and 1 table tennis player. The dislocations and Approximately 10% of registered athletes incurred an
­ruptures of the tendon or ligament affected 4 (3.2%) injury during the 2008 Olympic Games. This injury rate

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2170 Junge et al The American Journal of Sports Medicine

was considerably lower than those of the 1985 Junior injury differed substantially between the sports, and
Olympic Games (25% of 2871 athletes sought medical thus injury prevention programs should be tailor made
attention)27 and of the 1994 Australian University Games to the injury profile of the respective sport.
(19.5% of 5106 athletes incurred an injury that required Injuries were reported from all sports with the highest
medical attention)8 but substantially higher than for the injury risk in soccer, taekwondo, field hockey, handball,
1994 North Summer Games (55 of 6243 athletes received weightlifting, boxing, triathlon, and athletics. Laskowski
medical attention)26 and for the Badger States Summer et al26 found the highest percentage of injured athletes
Games 1994-1996 (285 of 31 580 athletes suffered a in judo, power lifting, and track and field, while Cunning­
reportable injury).14 Although these studies surveyed inju- ham and Cunningham8 found the highest percentage in
ries in large multisport events, the characteristics of the hockey, taekwondo, and soccer. Greene and Bernhardt14
athletes varied substantially between them and the pres- observed the highest injury rates in basketball, cycling,
ent study. Therefore, a comparison can only demonstrate wrestling, roller hockey, and soccer. Martin et al27 reported
the wide range of injury rates in different sports events. the most encounters for field hockey and soccer players.
Only one study on sports injuries during the Olympic Although there is a certain variation, it can be concluded
Games exists in the literature.21 At the 2004 Olympic that some team sports (such as soccer, handball, basket-
Games in Athens, all injuries incurred during team sports ball, and hockey) and some martial sports (especially
competitions were recorded using the same injury defini- taekwondo and wrestling) have a relatively high injury
tion and a similar mode of data collection.20,21 The total risk. On the other hand, the lowest injury risk during the
number of matches (2004: 488; 2008: 498) as well as the Beijing Olympics was observed for sailing, canoeing/
number of all in-competition injuries (2004: 378; 2008: kayaking, rowing, synchronized swimming, diving, fenc-
333) and time loss injuries in competition (2004: 147; ing, and swimming, which is also in agreement with the
2008: 150) were similar in the 2004 Olympic Games and literature.8,14,26,27
the present study. With respect to the single sports, the
number of time loss injuries in competition was similar in Limitations of the Study and Future Research
the 2004 and the 2008 Olympics for soccer, handball, base-
ball, softball, and water polo; lower for basketball (which The injury definition and methods applied have been dis-
might be partly due to rule changes regarding elbowing, cussed in detail in another publication.20 However, some
blocks, and contact without ball possession) and field limitations of the present study should be mentioned.
hockey; and higher for volleyball. In comparison to previ- Time loss for sport was based on the physician’s estimate
ous studies using a similar injury definition and surveil- of the number of days that the athlete will not be able to
lance system during single-sport tournaments, comparable undertake his or her normal training program or will not
injury rates have been reported for soccer,9,17-19 handball,25 be able to compete. A follow-up of the injured athletes
and athletics.1 could improve the validity of these data20 but was imprac-
About half of the injuries affected the lower extremity, tical because small NOCs have no associated medical per-
with contusions, sprains, and strains being the most com- sonnel. The causes of injury were described in given
mon types. This is in agreement with most publications on categories, and a more sophisticated analysis of injury
sports injuries.8,14,21,26,27 The diagnoses covered a wide mechanisms might provide more detailed information for
spectrum; however, ankle sprains and thigh strain were the development of a preventive program.23 For example,
the most prevalent diagnoses. It is worth mentioning that incidences of contact injuries should be studied with
10% of the injuries affected the head, mainly diagnosed as respect to the adequacy of rules to protect the athletes
skin lesions or contusions, but also 12 concussions were from injury and potential rule violation,2,11 and video
reported. The risk of concussion is a major concern in cer- analysis might help in the understanding of the mecha-
tain sports, and its diagnosis, treatment, and return-to- nisms of noncontact injuries.24 The present study focused
play guidelines have been the focus of recent consensus exclusively on injuries incurred in training and competi-
statements.4,29 About half of the injuries were reported to tion. Future studies should also include pre-existing
result in time loss from sport, which is comparable with (chronic) injuries and other medical conditions (such as
other studies using the same injury definition and similar illnesses or disease) because they also can significantly
assessment methods.1,9,17-19,21,25 affect the health and performance of the athletes.
The majority of injuries were incurred during competi-
tion and one quarter during training, which is in agree-
ment with a study on injuries during the 2007 World CONCLUSION
Athletics Championships using the same injury surveil-
lance system.1 Injuries in training and in competition dif- The injury surveillance system was accepted by all involved
fered significantly in all injury characteristics and with medical personnel and is feasible in a large multisport
regard to the different sports. In general, contact with event. The data indicate that the injury surveillance sys-
another athlete was the most frequent cause of injury, fol- tem covered almost all participating athletes. The consist-
lowed by noncontact trauma and overuse. Other potential ent findings with previous studies demonstrate the high
causes of injury such as equipment failure and field and quality of the data obtained. About 10% of the athletes
weather conditions were rare. However, the causes of incurred an injury during the 2008 Beijing Olympic

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Vol. 37, No. 11, 2009 Sports Injuries During the Summer Olympic Games 2008 2171

Games, half of them a time loss injury. The diagnoses, 12. Fuller CW, Junge A, Dvorak J. A six year prospective study of the
causes, and risks of injury differed substantially between incidence and causes of head and neck injuries in international foot-
ball. Br J Sports Med. 2005;39 Suppl 1:i3-9.
the sports. Therefore, injury prevention programs should
13. Fuller CW, Laborde F, Leather RJ, Molloy MG. International Rugby
be tailor made to the injury profile of the respective sport. Board Rugby World Cup 2007 injury surveillance study. Br J Sports
In future Olympic Games, the injury surveillance should Med. 2008;42(6):452-459.
be continued and, if possible, extended with respect to fol- 14. Greene JJ, Bernhardt D. Medical coverage analysis for Wisconsin’s
low-up of severe injuries, more sophisticated analysis of Olympics: the Badger State Games. Wis Med J. 1997;96(6):
injury mechanisms, and the inclusion of chronic injuries 41-44.
and sports-related illnesses. 15. Hutchinson MR, Laprade RF, Burnett QM 2nd, Moss R, Terpstra J.
Injury surveillance at the USTA Boys’ Tennis Championships: a 6-yr
study. Med Sci Sports Exerc. 1995;27(6):826-830.
16. Jakoet I, Noakes TD. A high rate of injury during the 1995 Rugby
ACKNOWLEDGMENT World Cup. S Afr Med J. 1998;88(1):45-47.
17. Junge A, Dvorak J. Injuries in female football players in top-level
The authors highly appreciate the cooperation of the National international tournaments. Br J Sports Med. 2007;41 (Suppl 1):i3-7.
Olympic Committees team physicians and therapists as well 18. Junge A, Dvorak J, Graf-Baumann T. Football injuries during the
as of the medical personnel of the Beijing Organizing World Cup 2002. Am J Sports Med. 2004;32(1 Suppl):23S-27S.
Committee of the Olympic Games who volunteered their 19. Junge A, Dvorak J, Graf-Baumann T, Peterson L. Football injuries
during FIFA tournaments and the Olympic Games, 1998-2001: devel-
time to collect the data for this project. We thank Dr Yong Wu
opment and implementation of an injury-reporting system. Am J
very much for his assistance during the preparation of the Sports Med. 2004;32(1 Suppl):80S-89S.
study and the data collection. We acknowledge Ms Agnes 20. Junge A, Engebretsen L, Alonso JM, et al. Injury surveillance in multi-
Gaillard and Mrs Gudrun Grasshoff for their valuable sport events: the International Olympic Committee approach. Br J
assistance with the collection of injury report forms and the Sports Med. 2008;42(6):413-421.
input of data. The authors thank Professor Arne Ljungqvist, 21. Junge A, Langevoort G, Pipe A, et al. Injuries in team sport tourna-
ments during the 2004 Olympic Games. Am J Sports Med. 2006;34(4):
chairman of the IOC Medical Commission, Dr Patrick
565-576.
Schamasch, IOC medical director, and the members of the 22. King DA, Gabbett TJ, Dreyer C, Gerrard DF. Incidence of injuries in the
IOC Medical Commission for their support of the project. We New Zealand national rugby league sevens tournament. J Sci Med
gratefully acknowledge the International Olympic Committee Sport. 2006;9(1-2):110-118.
(IOC) and the Fédération Internationale de Football 23. Krosshaug T, Andersen TE, Olsen OE, Myklebust G, Bahr R.
Association (FIFA) for funding of the study. Research approaches to describe the mechanisms of injuries in
sport: limitations and possibilities. Br J Sports Med. 2005;39(6):
330-339.
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