Scand J Med Sci Sports 2014: 24: e320–e331 © 2014 John Wiley & Sons A/S.

doi: 10.1111/sms.12175 Published by John Wiley & Sons Ltd

Review

Sports-related injuries in athletes with disabilities

K. Fagher1, J. Lexell1,2,3
1
Department of Health Sciences, Lund University, Lund, Sweden, 2Department of Rehabilitation Medicine, Skåne University Hospital,
Lund, Sweden, 3The Swedish Sports Organization for the Disabled and The Swedish Paralympic Committee, Lund, Sweden
Corresponding author: Kristina Fagher, RPT, MSc, Department of Health Sciences, Rehabilitation Medicine Research Group, Lund
University, PO Box 157, 221 00 Lund, Sweden. Tel: +46 46 222 1991, Fax: +46 46 222 1808, E-mail: [email protected]
Accepted for publication 9 December 2013

The number of athletes with disabilities participating in EMBASE, CINAHL, and Google Scholar were systemati-
organized sports and the popularity of the Paralympic cally searched and 25 of 605 identified studies met the
Games is steadily increasing around the world. Despite inclusion criteria. Lower extremity injuries were more
this growing interest and the fact that participation in common in walking athletes, whereas upper extremity
sports places the athlete at risk for injury, there are few injuries were more prevalent in wheelchair athletes. The
studies concerning injury patterns, risk factors, and pre- methodologies and populations varied widely between the
vention strategies of injuries in disabled athletes. In this studies. Few studies were sports or disability specific,
systematic literature search and critical review, we sum- which makes it difficult to determine specific risk factors,
marize current knowledge of the epidemiology of sports- and few studies reported injury severity and prevention
related injuries in disabled athletes and describe their of injuries. Further longitudinal, systematic sports and
characteristics, incidence, prevalence, and prevention disability specific studies are needed in order to identify
strategies. The outcomes of interest were any injury, and prevent injuries in athletes with disabilities.
either an acute trauma or an overuse event. PubMed,

Exercise is frequently associated with health benefits interest in competitive and Paralympic sports, there has
and is widely recommended as a proactive behavior to been little research on injuries caused by sports participa-
reduce the risk of several diseases such as osteoporosis, tion among disabled athletes.
cardiovascular diseases, the metabolic syndrome, and In a health-care perspective, Paralympic sports poses
cancer (Pedersen & Saltin, 2006). For a disabled person, many challenges not faced in Olympic sports (Webborn
it is even more important to be physically active to & Van de Vliet, 2012). Existing studies show that the
improve and maintain cardiovascular fitness, self- overall rates of injuries are considerably high and
efficacy, and self-perceived quality of life (Blauwet & comparable with injury rates in able-bodied athletes.
Willick, 2012). Participation in organized sports is a However, data regarding the epidemiology of injuries,
natural way for people with disabilities to be physically time loss due to injury, injury severity, and sports and
active, and the opportunities to take part in organized disability specific risk factors are very limited. Further-
sports have increased markedly during the last decades. more, very few studies have assessed injury prevention
However, participation in sports also increases the risk strategies. The aim of this systematic literature search
of sports-related injuries, either acute trauma or overuse and critical review was therefore to bring together
injury. An injury may lead to morbidity and mortality current knowledge about injury epidemiology with a
(Kjaer et al., 2005; Ljungqvist et al., 2009) and the indi- focus on prevalence, incidence, etiology, risk factors,
vidual could lose training time and working/school time. and prevention strategies of sports-related injuries in ath-
Furthermore, sports-related injuries can be a burden for the letes with disabilities participating in organized sports
society, with medical treatment, rehabilitation, and reduced and Paralympic sports.
work capacity (Kjaer et al., 2005). For the disabled athlete,
an injury could also have more serious consequences com- Methods
pared with an able-bodied athlete. For example, an upper
extremity muscle strain may influence the throwing in an This review is based on a structured systematic literature search that
able-bodied javelin thrower, whereas it will affect both was conducted in the following databases: PubMed, CINAHL,
EMBASE, and Google Scholar. The first database search was
sports participation and activities of daily living in a dis- completed before the 25th of April 2013 and updated on 1st of June
abled wheelchair javelin thrower (Vanlandewijck & 2013. The literature search employed the following keywords:
Thompson, 2011). Despite the growing popularity and “sports” AND “Paralympic” OR “disability” AND “wounds and

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injuries” OR “injury” AND “epidemiology” NOT “review”. The studies reported sports and disability specific injuries
search produced 605 results (Fig. 1). In addition, each reference list together. Sports that featured most were swimming,
from the identified articles was cross-checked to verify that relevant
articles were not missed. The same eligibility criteria were consid-
wheelchair basketball, and athletics. No studies reported
ered in the screening of titles, abstracts, and full text. injuries in triathlon or canoe. A majority of studies
reported injuries to the musculoskeletal system, i.e.,
injuries to the upper or lower extremities, whereas very
Eligibility criteria and selection process few reported other type of injuries, such as head injuries
To be eligible for inclusion, each study needed to be: (a) written in (concussion) or injuries to the internal organs.
English; (b) published in a peer-reviewed journal between January In the following section, we start by summarizing
1985 and June 2013; (c) include disabled athletes participating in studies describing overall injury epidemiology, then
organized sports or Paralympic sports; and (d) present adequate
quantitative results. The conditions of interest were sports-related injuries specific to wheelchair athletes, injuries specifi-
injuries, either acute injury and/or overuse injury. A total of 43 poten- cally reported during winter sports, and finally acute vs
tially relevant studies were found, assessed, and evaluated against the nonacute injuries. In Table 1, we present the character-
eligibility criteria; 28 studies were not in the area of interest, and 14 istics of the 25 reviewed studies. In Fig. 2, the injuries
other studies were identified through other sources. Finally, 29 are described by body location in the 18 studies that
studies were included for detailed evaluation; four were subsequently
excluded because they did not meet the eligibility criteria. Thus, 25 included these data, and in Table 2, studies reporting
remaining studies are included in this review (Fig. 1). sports-specific injuries are presented.

Results Overall injury epidemiology

Summary of search results In this section, we describe the overall injury epidemiol-
Of the 25 included studies, 10 studies were prospective ogy of the reviewed studies. Lower extremity injuries
and 15 retrospective studies. Thirteen studies were older appeared to be more common in walking athletes [ampu-
than 10 years, and 18 studies had a definition of injury. tees, visual impairments (VIs) and cerebral palsy (CP)]
Ten studies used prevalence as outcome (9–86%), seven (Athanasopoulos et al., 2009; Patatoukas et al., 2011;
reported incidence rate (IR), and eight of the studies Magno e Silva et al., 2013b, c). During the 1996 Summer
reported incidence. Fourteen studies separated the inju- Paralympic Games in Atlanta, USA, athletes with a uni-
ries as acute or nonacute, 12 reported disability-specific lateral amputation from Disabled Sports USA suffered
injuries, and 20 reported sports-specific injuries. Nine from a higher injury frequency in the ankle region

Fig. 1. Flow chart of the literature search.

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Table 1. Characteristics of studies and type of injuries

Author, (publication Population, disability, sports, and follow-up Injury definition Results Type of injuries
year), type of study period

Athanasopoulos n = nr nr 131 athletes Acute injuries 64.1%

et al. (2009 Age: mean 31.4 years reported Overuse injuries 22.1%
Retrospective IPC impairments* injury 28.2% tendinopathy
Paralympic Sports† Most injuries to the upper extremity among
Physiotherapy Service at the Paralympic (WA)
Summer Village Polyclinic 2004 Most injuries to the lower extremity among
(VI)
Bernardi et al. n = 227 Any muscle pain during the past 12 Prevalence 56% shoulder injuries
(2003) Age: range 12–60 years months during sport activity at 50.7% Increased prevalence rate of sports-related
Retrospective CP, SCI, amputees, “les autres” least 1 day muscle pain with increased training
Swimming, track and field, basketball volume
1 year
Burnham et al. n = 151 nr 84 injuries in Acute injuries 49%
(1991) Age: nr 151 athletes Overuse injuries 51%
Retrospective IPC impairments* 21.4% of all injuries classified as rotator
Paralympic Sports† cuff impingement
Paralympic Summer Games 1988 High number of lower extremity injuries in
(VI)
Chung et al. n = 14 Trauma that occurred during a Incidence 73.8% upper extremity injuries
(2012) Age: mean 28.6 training/competition and prohibited 3.9/1000 h 58.9% strain
Prospective Wheelchair athletes the athlete from continuing fencing Wheelchair fencers had a higher overall
Wheelchair foil fencing activity for at least 1 day injury incidence rate than abled-bodied
3 years fencers
Curtis and Dillon n = 128 nr Prevalence 72% 33% soft tissue injuries
(1985) Age: mean 29 A high number of training hours was related
Retrospective SCI, congenital disorders, postpolio, to a high number of injuries
amputees, neuromuscular disorders
Wheelchair sports; track, basketball, field,
swimming, road racing
nr
Curtis and Black n = 46 The Wheelchair User’s Shoulder Pain Prevalence 52% 72% reported shoulder pain and 70%
(1999) Age: mean 33 Index reported hand or elbow pain since start of
Retrospective Female wheelchair athletes wheelchair use
Wheelchair basketball
One tournament
Ferrara and n = 19 Anything the athlete expressed 50 injuries in 19 Acute injuries 65%
Davis (1990) Age: mean 29.5 concern about and caused loss of athletes Overuse injuries 23%
Retrospective Wheelchair athletes participation due to injury or illness 48% strains
Wheelchair; track and field, shooting, 58% upper extremity injuries
swimming, table tennis 32% of the injuries caused a time loss of 22
1 year days or more of participation in sport
Ferrara et al. n = 426 Any trauma to the participant that Prevalence 32% Acute injuries 45.9%
(1992a) Age: mean 25.7 occurred during any practice, Overuse injuries 54.1%
Retrospective Track, field, weightlifting, swimming training, or competition session 44.3% upper extremity injuries
Wheelchair users, CP, VI that caused the athlete to stop, The athletes with disability demonstrated
National Competition 1989 limit, or modify participation for 1 approximately the same percentage of
day or more injury as the athlete without a disability in
similar sports activities
Ferrara et al. n = 68 Any trauma to the participant that 100 injuries in Acute injuries 40%
(1992b) Age: mean 29.6 occurred during any practice, 68 athletes Overuse injuries 60%
Retrospective Amputees, SCI, VI, spina bifida, MS, training, or competitive session that 51% upper extremity injuries
muscular dystrophy resulted in the cessation, limitation,
Skiing or modification of the athlete’s
Six months participation for at least 24 h
Ferrara et al. n = 1360 Any injury/illness that was evaluated 1037 Acute injuries 67.9%
(2000) Age: nr by the U.S. medical staff during the injuries/1360 Overuse injuries 20.6%
Prospective Wheelchair users, CP, VI, dwarf study period athletes 22.1% sprains
Multisports The most commonly body location was
5 competitions, 6 years thorax/spine
Magno e Silva n = 13 Symptom 1 day or more Incidence 2.7 Acute injuries 80%
et al. (2013b) Age = nr Incidence rate Overuse injuries 20%
Prospective VI 0.12 31% contusions
Blind football Prevalence 86% Most common with lower extremity injuries
4 years (5 competitions)
Magno e Silva n = 40 Symptom 1 day or more Incidence 0.93 Acute injuries 18%
et al. (2013c) Age = nr Incidence rate Overuse injuries 82%
Prospective VI 0.39 26% spasm
Track and field Prevalence 78% Most common with lower extremity injuries
4 years (5 competitions)
Magno e Silva n = 28 Any injury that caused an athlete to Incidence 1.5 Acute injuries 20%
et al. (2013a) Age = nr stop, limit, or modify participation Incidence rate Overuse injuries 80%
Prospective VI for 1 or more days. 0.3 36.6% spasm
Swimming Prevalence 64% Most common with injuries in the shoulder,
4 year (5 competitions) 29.3%

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Table 1. (continued)
Author, (publication Population, disability, sports, and follow-up Injury definition Results Type of injuries
year), type of study period

McCormack n = 90 Trauma that incurred while training, 346 injuries/90 24.9% blisters
et al. (1991) Age = mean 28 practicing, or competing in athletes Upper extremity injuries most common
Retrospective SCI, amputees, CP, spina bifida, wheelchair sports
neurological and congenital disorders,
WA
4 competitions, all past injuries recorded
McCormick n = 60 nr Incidence Knee injuries most common, 17.4%
(1985a) Age = mean 32 2.0/1000 skiers Lower injury incidence compared with
Retrospective Amputees, postpolio, VI days able-bodied athletes
Alpine skiing 23 injuries in 60
1 day, all past injuries recorded athletes
McCormick n = 23 nr Incidence Most common with shoulder injuries,
(1985b) Age = range 22–54 16.1/1000 skiers 33.3%
Retrospective Paraplegia, amputees, brain trauma, MS, day Sit-skiers were eight times more likely to
arthrogryposis, 21 injuries in 23 sustain an injury than disabled athletes
vascular disease athletes not using a sit ski
Sit skiers
1 day, all past injuries recorded
Nyland et al. n = 304 Soft tissue injuries; strain, sprain, 254 injuries/304 Acute injuries 67%
(2000) Age = -nr tendonitis, bursitis, contusion athletes Overuse injuries 33%
Prospective IPC impairments* 20.9% shoulder injuries
Paralympic Sports†
Summer Paralympics 1996
Ramirez et al. n = 210 Events resulting in immediate removal Incidence 2.0 44.7% lower extremity injuries
(2009) Age = mean 18 of the athlete from the session and injuries/1000 31.6% abrasion
Prospective Autism, emotional disturbance, mental medical treatment by school staff sessions Athletes with autism, a history of seizure,
retardation, learning disability, or transport to a hospital. A played and emotional disturbance had a higher
orthopedic disability, sensory disability physical trauma that was sustained injury rate
Basketball, field hockey, soccer, and to the body region of an athlete
softball during the injury event.
4 seasons
Reynolds et al. n = 203 nr 291 team Most common with injuries in the upper
(1994) Age = nr members, 201 extremity and the cervical spine
Retrospective IPC impairments* attended the The injury/illness profile was similar to
Paralympic Sports† medical center those in abled-bodied sport
Summer Paralympics 1992
Patatoukas et al. n = 139 Any injury that caused an athlete to Incidence SCI 58.9% soft tissue injuries
(2011) Age: mean 32.8 stop, limit, or modify participation athletes 1.47, The number of fractures significantly higher
Retrospective SCI, postpolio, CP, amputees, “les autres” for 1 day or more, all injuries in CP 0.97, other in SCI athletes
Wheelchair basketball, track and field, athlete’s sport life included disabled
swimming, gym, powerlifting, athletes 1.16
wheelchair dancing, shooting 178 injuries in
1 competition 69 athletes
Sobiecka (2005) n = 114 nr 125 injuries/114 Injuries to the motor system
Retrospective Age: mean 27 women, 30 men athletes
VI, amputees, SCI, CP, intellectual disability
Paralympic Sports†
Summer Paralympics 2000
Taylor and n = 53 Symptom 1 day or more Prevalence 72% Acute injuries 16%
Williams Age: nr Overuse injuries 52%
(1995) Wheelchair athletes 52% upper extremity injuries
Retrospective Wheelchair racing Overuse injuries recurred more often
1 year
Webborn et al. n = 416 Any injury during the games Prevalence 9% Acute injuries 77%
(2006) Age: mean 33.0 Overuse injuries 15%
Prospective IPC impairments* 32% sprains
Paralympic Sports‡ 21% resulted in time lost from participating
Winter Paralympics 2002 (20 days) in sport
Webborn et al. n = 505 Any sport-related musculoskeletal Incidence Acute injuries 41%
(2012) Age: range 19–53 complaint that caused the athlete to proportion Overuse injuries 58%
Prospective IPC impairments* seek medical attention during the 23.8% Increase of injuries in Paralympic Winter
Paralympic Sports‡ study period games
Winter Paralympics 2010
Willick et al. n = 3565 Any sport-related musculoskeletal or Incidence rate Acute injuries 51.5
(2013) Age: mean 30 neurological complaint prompting 12.7/1000 Overuse injuries 31.8
Prospective IPC impairments* an athlete to seek medical attention, athlete days Acute on chronic 16.7%
Paralympic Sports† regardless of whether or not the Injury proportion 50.2% upper extremity injuries
Summer Paralympics 2012 complaint resulted in lost time from 17.8/100 Higher injury rates in older athletes
training or competition athletes

*IPC impairments: impaired muscle power, impaired passive range of movement, limb deficiency, leg length difference, hypertonia, ataxia, athetosis, short stature, vision
impairment, and intellectual impairment.
†
Paralympic Summer Sports (until 2012): football 5-a-side, powerlifting, goalball, wheelchair fencing, wheelchair rugby, athletics, judo, wheelchair tennis, table tennis,
wheelchair basketball, football 7-a-side, seated volleyball, cycling track, equestrian, swimming, archery, boccia, cycling road, sailing, rowing, and shooting.
‡
Paralympic Winter Sports: alpine skiing, biathlon, cross-country skiing, wheelchair curling, ice sledge hockey.
CP, cerebral palsy; MS, multiple sclerosis; nr, not reported; SCI, spinal cord injury; VI, vision impairment; WA, wheelchair athletes.

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compared with other categories of athletes (Nyland et al.,
2000). A limitation of this prospective study is that only
soft tissue injuries were reported (Table 1). Magno e Silva
et al. (2013b) reported an injury prevalence of 84.6% in a
population of 13 male Brazilian soccer players with VI
during five major competitions; the clinical incidence was
2.7 injuries per athlete. The most common injuries were
contusions and sprains, and 80% of the injuries were
acute. The most common injury site was the lower limb
(80%), and 29% of the injuries occurred in the knee. A
limitation of this longitudinal study is that injuries were
only reported during competitions. Similar injury pat-
Fig. 2. Injuries presented by body location in the 18 studies that terns were seen in the Union of European Football Asso-
included these data. Data are presented as minimum and ciations (UEFA) injury study in able-bodied soccer
maximum, and range. players, where 87% of the injuries occurred in the lower
extremity and 81% resulted from trauma. On average,
each player suffered from 2.0 injuries/season (Ekstrand
et al., 2011).

Table 2. Studies reporting sports-specific injuries in current Paralympic Summer and Winter sports

Summer sports Studies Winter sports Studies

Archery Reynolds et al. (1994); Willick et al. (2013) Alpine skiing McCormick (1985a, b); McCormack et al.
(1991); Webborn et al. 2006; 2012)
Athletics Athanasopoulos et al. (2009); Bernardi et al. (2003); Biathlon Webborn et al. (2012)
Curtis and Dillon (1985); Ferrara and Davis (1990); Cross-country Webborn et al. 2006; 2012)
Magno e Silva et al. (2013c); McCormack et al. (1991); skiing
Patatoukas et al. (2011); Reynolds et al. (1994); Taylor Ice sledge hockey Webborn et al. 2006; 2012)
and Williams (1995); Willick et al. (2013) Wheelchair curling Webborn et al. (2012)
Canoe –
Cycling Athanasopoulos et al. (2009); Reynolds et al. (1994);
Willick et al. (2013)
Equestrian Athanasopoulos et al. (2009); Willick et al. (2013)
Football 5-a-side Magno e Silva et al. (2013b); Willick et al. (2013)
Football 7-a-side Reynolds et al. (1994); Willick et al. (2013)
Goalball Athanasopoulos et al. (2009); Willick et al. (2013)
Wheelchair dance Patatoukas et al. (2011)
sport
Judo Athanasopoulos et al. (2009); Reynolds et al. (1994);
Willick et al. (2013)
Powerlifting/ Athanasopoulos et al. (2009); McCormack et al. (1991);
weightlifting Patatoukas et al. (2011); Reynolds et al. (1994); Willick
et al. (2013)
Rowing Willick et al. (2013)
Sailing Willick et al. (2013)
Shooting Patatoukas et al. (2011); Reynolds et al. (1994); Willick
et al. (2013)
Volleyball Athanasopoulos et al. (2009); Reynolds et al. (1994);
Willick et al. (2013)
Swimming Athanasopoulos et al. (2009); Bernardi et al. (2003);
Ferrara and Davis (1990); Magno e Silva et al. (2013a);
Reynolds et al. (1994); McCormack et al. (1991);
Patatoukas et al. (2011); Willick et al. (2013)
Table tennis Athanasopoulos et al. (2009); Reynolds et al. (1994);
Willick et al. (2013)
Triathlon –
Wheelchair Athanasopoulos et al. (2009); Bernardi et al. (2003);
basketball Curtis and Dillon (1985); Curtis and Black (1999);
McCormack et al. (1991); Patatoukas et al. (2011);
Reynolds et al. (1994); Willick et al. (2013)
Wheelchair Athanasopoulos et al. (2009); Chung et al. (2012);
fencing Reynolds et al. (1994); Willick et al. (2013)
Wheelchair rugby McCormack et al. (1991); Willick et al. (2013)
Wheelchair tennis Athanasopoulos et al. (2009); Curtis and Dillon (1985),
Reynolds et al. (1994); Willick et al. (2013)

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During the 2012 Summer Paralympic Games in However, this study has a poor description of method
London, UK, a prospective injury surveillance system was and injury definition. Patatoukas et al. (2011) showed in
used. Football 5-a-side had the highest injury IR with 22.4 a retrospective survey that a population of Greek elite
injuries/1000-athletes days (overall IR 12.7); 54% of the athletes with locomotor disabilities participating in
injuries were acute. Football 7-a-side had a lower IR standing track and field events had the second highest
(11.2); 73% of these injuries were classified as acute percentage of injury (23.0%) among nine different sports
(Willick et al., 2013). Goalball had the second highest (41 injuries were reported in 35 athletes). Burnham et al.
injury IR (19.5); 77% of the injuries were classified as (1991) showed in a retrospective cohort study that ath-
acute. Sports specificity, age, gender, and disability classi- letes involved in stand-up track events, long jump, and
fication were included as baseline covariates in the study high jump had a significantly higher frequency of lower
from the 2012 Paralympic Games, and it is recommended extremity injuries during the 1988 Paralympic Games in
that future studies follow a similar approach. Another Seoul, South Korea, compared with athletes involved in
strength of this study is the reporting of incidence propor- sports using predominantly their upper extremity.
tions and IRs based on exposure. However, disability- Swimming had a lower injury IR (8.7) compared with
specific injuries were not reported (Willick et al., 2013). the overall injury IR (12.7) during the 2012 London
In a retrospective survey of 426 competitive disabled Paralympic Games; 47% of the injuries were classified
athletes in the United States, a high number of the lower as acute, whereas 37% were overuse injuries and 16%
extremity injuries occurred in ambulatory athletes with were acute on chronic injuries (Willick et al., 2013).
polio. In CP athletes, the knee (21%) was the most vul- During the Summer Paralympic Games 1992 in Barce-
nerable and injured body part. Also, VI athletes had a lona, 69% of the swimmers in the British team reported
high percentage of lower extremity injuries (53%), and an injury during the games (Reynolds et al., 1994).
the leg/ankle was involved in 26% of all injuries (Ferrara McCormack et al. (1991) reported that wheelchair
et al., 1992a). Soccer had the highest IR (3.7 injuries per swimmers had one of the lowest injury frequencies
1000 athlete exposure) in a population of 210 athletes (1.2%) in a population of 90 wheelchair athletes.
participating in organized high school sport in the United Patatoukas et al. (2011) reported 34 injuries in 51 swim-
States; 44.7% were lower extremity injuries and athletes mers in their study among Greek elite athletes, and
with autism, a history of seizure and emotional distur- swimming had the third largest injury prevalence
bance had a higher injury rate. The athletes were fol- (19.1%). Magno e Silva et al. (2013a) reported a preva-
lowed during one season (Ramirez et al., 2009). lence of 64.3% and a clinical incidence of 1.5 in a pro-
Magno e Silva et al. (2013c) documented injuries lon- spective study among a population of 28 VI swimmers;
gitudinally during five major competitions in a popula- 80% of the injuries were overuse injuries, and the most
tion of 40 Brazilian track and field athletes with VI, affected body part was the shoulder (29.3%).
giving a prevalence of 78% and a clinical incidence of Taken together, lower extremity injuries are common
1.93 injuries per athlete. The most frequently reported in walking athletes, especially in those with VI and in
diagnoses were spasms and tendinopathies, and 82% those participating in ball sports and track and field, and
of the injuries occurred in the lower limbs (Magno e the prevalence of injuries in swimming seems to vary.
Silva et al., 2013c). Also Athanasopoulos et al. (2009) However, it is difficult to compare the results as most
reported a high injury prevalence in track and field ath- studies have used different rate denominators and defi-
letes. Over half (51.2%) of the total number of injuries nitions of injury.
that were admitted to the physiotherapy department of
the 2004 Summer Paralympic Village Polyclinic in
Athens, Greece, occurred among track and field athletes. Wheelchair athletes
Most of these injuries (22.1%) occurred in VI athletes. Wheelchair sports are specific to disabled athletes, and
Lower extremity injuries were more common than inju- the epidemiology of injuries occurring in these types of
ries to the upper extremities in athletes with VI, CP, and sports are also specific to this population of athletes.
amputation. The documentation of injuries was based on Taylor and Williams (1995) reported an injury preva-
the physiotherapy treatment reports, and a limitation of lence of 72% during a 12-month period in a retrospective
the study is that no definition of injury was present. study among a population of 53 British wheelchair
During the 2012 London Paralympic Games, 216 inju- racing athletes, where the most common disability was
ries were reported in the 977 athletes participating in spinal cord injury (SCI) (56%). Mostly, upper extremity
track and field. The IR was 15.8 injuries/1000 athletes- injuries were reported; 27% occurred in the hand and
days (overall IR 12.7), and 50% of the injuries had an wrist followed by 25% in the upper arm and shoulder.
acute onset, whereas 21% were acute on chronic and Fifty injuries were reported in a population of 19 U.S.
29% were overuse injuries (Willick et al., 2013). At the elite wheelchair athletes participating in track and field,
1992 Summer Paralympic Games in Barcelona, Spain, swimming, table tennis, and shooting (Ferrara & Davis,
80% of the track and field athletes in the British 1990). In this retrospective study, a total of 60% of the
team suffered from an injury (Reynolds et al., 1994). injuries occurred in track and field, and 48% occurred

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during the competitive season. The most common type participated in sports and leisure activities on average
of injury was strain (48%), and the most frequently 11 h per week. A limitation of this study is that just
injured area was the shoulder (27.6%). The authors con- injuries to the upper extremity were recorded.
cluded that the time loss factor appeared to be higher for During the 2012 London Summer Paralympic Games,
major injuries when compared with athletes without dis- 34 injuries were reported in 202 wheelchair basketball
ability. Only time-loss injuries were recorded, and the athletes (IR 12.0, overall IR 12.7) and 65% of these
results may therefore be biased. injuries had an acute onset (Willick et al., 2013). During
Curtis and Dillon (1985) retrospectively assessed the the Summer Paralympics 1992 in Barcelona, Spain, 79%
injury prevalence of 128 U.S. wheelchair athletes. The of the British basketball team players suffered from an
most common disability was SCI, and the largest per- injury (Reynolds et al., 1994). McCormack et al. (1991)
centage of athletes were involved in track and field reported that wheelchair basketball players were the ath-
(79%) followed by basketball and swimming. As many letes with the highest injury frequency (30.9%) in a
as 72% of the athletes reported that they had been injured group of 90 Canadian wheelchair athletes, and upper
at some time during their career. Soft tissue injuries in extremity injuries were the most common. Also,
shoulders, elbows, and wrists were the most frequently Patatoukas et al. (2011) showed that wheelchair basket-
reported injuries. The sports associated with the highest ball was the sport with the highest percentage of injury
injury prevalence were track and field (26%) and basket- (30.9) among a group of Greek elite athletes.
ball (24%). A significantly high proportion of injuries Chung et al. (2012) demonstrated in a prospective
were reported in athletes aged 21–30 years. Noteworthy study that wheelchair foil fencers had a higher overall IR
is the low response rate – the questionnaire was distrib- (3.9/1000 h) compared with able-bodied fencers (2.4/
uted to 1200 athletes (response rate just over 10%) – as 1000 h). Furthermore, wheelchair athletes without active
well as the possibility of recall bias. Ferrara et al. trunk control were more susceptible to injury (4.9/
(1992a), also in a retrospective survey, reported that the 1000 h) compared with athletes with good trunk control
upper extremity was involved in injuries twice as often (3.0/1000 h). The most prevalent injuries in the wheel-
as the lower extremity in athletes from the U.S. National chair athletes were upper extremity injuries (73.8%),
Wheelchair Athletics Association. A limitation of this whereas the able-bodied fencers had a higher percentage
study is that only traumatic injuries were registered. of lower extremity injuries. Four of the 14 wheelchair
During the Summer Paralympic Games 2004 in Athens, fencers were absent from their sport for more than 22
the majority of injuries reported to the Paralympic Village days because of a major injury. Willick et al. (2013)
Physiotherapy Service occurred among wheelchair athletes reported an injury IR of 18.0 injuries/athletes-days
(51.2%). The most common injury site in the 67 injured (overall IR 12.7) in wheelchair fencing during the 2012
wheelchair athletes was in the shoulder (50.1%) and spine London Paralympic Games; 58% of the injuries were
(20.1%) (Athanasopoulos et al., 2009). During the same overuse injuries. During the Paralympic Games 1992,
games, athletes from the Wheelchair Sports USA had a 71% of the fencers suffered from injury in the British
higher frequency of elbow, forearm, and wrist injuries than team (Reynolds et al., 1994).
other categories. However, wheelchair athletes had not a In summary, mostly upper extremity injuries, espe-
higher frequency of shoulder injuries compared with other cially in the shoulder, are reported in wheelchair athletes,
groups (Nyland et al., 2000). Also, during the 2012 London confirming that these types of injuries are overrepre-
Paralympic Games, wheelchair athletes had high injury sented among these athletes. Once again, different rate
rates. Wheelchair rugby (IR 16.3) and wheelchair tennis denominators and definitions of injury cause inconsis-
(IR12.8) had higher injury IRs than the overall injury IR tencies in the reported data and comparisons of results
(12.7). Upper extremity injuries were the most common are therefore difficult.
during the 2012 London Games (Willick et al., 2013).
McCormack et al. (1991) retrospectively surveyed
90 Canadian wheelchair athletes participating in 18 Winter sports
different wheelchair sports. In total, 346 injuries were Five sports – alpine skiing, biathlon, cross-country
reported. Upper extremity injuries were the most skiing, ice sledge hockey, and wheelchair curling – are
common, and the authors suggested that the high fre- included in the Winter Paralympic Games. During the
quency of upper extremity injuries were probably due to 2002 Winter Paralympic Games in Salt Lake City, USA,
wheelchair propulsion. A limitation of this study is that the International Paralympic Committee (IPC) started
just trauma-related injuries were registered. Curtis and prospective injury surveillances. Alpine skiers were the
Black (1999) showed in a retrospective study that 52% athletes that experienced most injuries (62% of all
of a population of female wheelchair basketball players injuries), and 12.3% of all alpine skiers (n = 194) suf-
suffered from current shoulder pain during a tournament. fered from at least one injury. The most serious injuries
A total of 70% of the athletes reported a history of elbow reported were anterior cruciate ligament ruptures, distal
or hand pain after beginning with wheelchair driving, radius fractures, and concussions. One of the conclu-
and 72% had a history of shoulder pain. The athletes sions of the 2002 injury surveillance was that a risk

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factor for injury in alpine skiing may be failure of ski- Interestingly, a remarkable increase in injury incidence
bindings to release (Webborn et al., 2006). During the proportion was seen during the 2010 Paralympic Winter
2010 Winter Paralympic Games in Vancouver, Canada, Games (IP = 23.8%) compared with the Winter Games
alpine skiing had the second highest injury incidence 2002 (IP = 9.4%), and a noteworthy high prevalence
proportion (21.6%). The sitting class athletes had a (57.5%) of overuse injuries was reported 2010. The authors
higher injury rate with 1.7 injuries/100 race exposures suggested that the high number of overuse injuries might be
compared with 0.7 injuries/100 race exposures in VI due to an increased level of training during the preceding
athletes and standing class athletes (Webborn et al., years (Webborn et al., 2012). In conclusion, the reported
2012). Ferrara et al. (1992b) reported 100 time-loss inju- injury prevalence in Paralympic Winter sports appears to
ries in a retrospective study in 68 skiers prior to the vary. Injuries are reported both to the lower and upper
National Games of Handicapped Sports and Blind Ath- extremities and seem to have both acute and chronic onset.
letes in the United States 1989. Upper extremity injuries
were 1.4 times more common than lower extremity inju-
ries; 60% of the injuries were classified as chronic. The Acute vs nonacute injuries
shoulder (30%) was the most vulnerable body location, Overuse injuries have lately gained increased attention in
and acute injuries were most prevalent in the thigh and the literature of sports injury epidemiology. These inju-
knee (30%). A limitation of this study is that only traumas ries are frequently seen in sports involving repetitive
were recorded. An IR of two injuries per 1000 skier-days movements and could lead to devastating consequences
was reported in a population of disabled alpine skiers in for the athlete. The mechanisms of injury are often a
the United States; 23 injuries were reported in 60 ath- result of repeated micro-trauma to the tissue, with no
letes, mostly amputees. The knee (17.4%) was the most single identifiable incident responsible for injury (Fuller
commonly injured body location, and 21.6% of the inju- et al., 2006). Clarsen et al. (2013) showed that overuse
ries were fractures (McCormick, 1985a). A higher IR injuries represented 49% of all health problems (acute
(16.1 injuries per 1000 skier-days) was shown in a similar injuries 13%) in 116 Norwegian Olympic and 26
study including 23 disabled sit-skiers. Individuals with Paralympic athletes preparing for the 2012 Summer
SCI at T6 or above had a higher injury frequency Olympic/Paralympic Games. This study is one of few
compared with those with paraplegia. Upper extremity prospective studies reporting injuries during normal
injuries were the most frequently reported injuries training and not only competition. During the Winter
(McCormick, 1985b). Both studies were retrospective Paralympic Games 2010, 57.5% of the injuries were
and did not report any definition of injury. overuse injuries (Webborn et al., 2012). Magno e Silva
Ice sledge hockey players had the highest rate of et al. (2013c) reported that 82% of the injuries, mostly in
injury per 100 athletes (14%) during the 2002 Winter the lower extremity, were overuse injuries in their study
Paralympic Games. Four of the injuries occurred from of VI track and field athletes. Similar results have been
collisions that resulted in lower limb injuries (Webborn demonstrated in able-bodied track and field athletes.
et al., 2006). Also, during the 2010 Winter Paralympic Jacobsson et al. (2013) reported that 96% of the injuries
Games, ice sledge hockey had the highest incidence pro- were nontraumatic, and 77% of the injuries were related
portion (33.9%) of all sports. A total of 40 of 118 athletes to the lower extremity in a population of able-bodied
required medical attention for musculoskeletal prob- elite track and field athletes in Sweden. In another study
lems. Of these, 60% of the injuries were classified as of VI swimmers, 80% of the injuries were classified as
overuse injuries, 52.5% of the injuries occurred during overuse injuries (Magno e Silva et al., 2013a). Also,
competition time and 42.9 of these, in turn, were contact Taylor and Williams (1995) reported a high prevalence
injuries. Upper extremity injuries were most common of overuse injuries in wheelchair athletes. Overuse inju-
(47.5%), followed by spine-related injuries (35%) ries were more likely to recur within 12 months, espe-
(Webborn et al., 2012). cially in those who started their training before the pain
Very few injuries were reported among the 134 ath- of the injury had disappeared. In wheelchair racing ath-
letes competing in the Nordic Skiing during the 2002 letes, 43% reported that they restarted training before the
Paralympic Games. Three injuries were reported, all pain had disappeared, and 71% of the injuries prevented
involving the upper limbs (Webborn et al., 2006). A large the athlete from training (the median time off training
increase in injury prevalence was seen during the Winter was 14 days). The authors suggested that there is a link
Paralympic Games 2010; 26 injuries were reported in between overuse injuries, restarting exercise before pain
140 athletes resulting in an injury prevalence of 18.6%. has disappeared and the rate of recurrence of injury.
Almost half (46.2%) of the injuries were classified as In a population of 227 Italian athletes with locomotor
acute, including serious injuries like concussions, pneu- disability, 51% experienced sports-related muscle pain that
mothorax, and fractures. VI athletes had a higher IR occurred during sports activity causing discomfort for at
based on a new acute injury (two injuries/100 race expo- least 1 day. A training volume above 7 h per week [odds
sures) compared with (1.3 injuries/100 race exposures) ratio 3.8; 95% confidence interval (1.4-10.0)] was associ-
for standing class athletes (Webborn et al., 2012). ated with pain (Bernardi et al., 2003). It has been suggested

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Fagher & Lexell
that there is a risk that the demands of sports activities tion. The conclusion of this study is that this method was
together with daily wheelchair pushing result in insuffi- sensitive and valid for recording injuries in a large group.
cient time for rest and recovery of the musculature in The authors also suggested that weekly reporting may
wheelchair athletes (Curtis & Black, 1999; Ferrara et al., lead to earlier and more comprehensive interventions of
2000). Curtis and Dillon (1985) showed with time expo- health issues. A limitation of this study is, however, the
sure data that a high number of hours per week spent on small number of Paralympic athletes surveyed.
training were associated with significantly higher injury In summary, a considerably high prevalence of sports-
prevalence. Athletes who reported most injuries were those related overuse injuries has been demonstrated in ath-
involved in repetitive wheelchair pushing. These results letes with disabilities. Two studies have shown that a
might be related to overuse of soft tissue structures. high number of hours per week spent on training are
Regarding traumatic injuries, Webborn et al. (2006) associated with higher injury prevalence. Overuse
reported that 77% of all injuries during the Winter injuries may be under-diagnosed, as some studies
Paralympic Games 2002, Vancouver, were acute inju- just include events related to trauma and competition in
ries. During the 2012 Summer Paralympic Games in their injury definitions (Table 1). Several authors have
London, 51.5% of the injuries were classified as trau- reported a high number of acute injuries during compe-
matic injuries. Boccia had the highest proportion of tition, and it seems like athletes participating in ball
acute traumatic injuries (91%), followed by goalball sports are more prone to acute injuries.
(77%). Also wheelchair rugby, football 7-a-side, seated
volleyball, and football 5-a-side had high proportions of
acute injuries (Willick et al., 2013). Ferrara et al. (2000) Risk factors and prevention of injuries
demonstrated that 65% of the injuries were acute in a In the sport medicine research area, preventative strategies
population of elite wheelchair athletes; 32% of the inju- have gained increased interest over the past years. Waldén
ries were classified as major (missing 22 days or more). et al. (2012) showed that anterior cruciate ligament injuries
In a longitudinal study following disabled U.S. athletes could be reduced by 64% when implementing a preventa-
over five international competitions, including the tive training program in female soccer players. Van
Summer Paralympic Games 1992 and 1996, the authors Beijsterveldt et al. (2013), however, reported conflicting
recorded 1037 injuries in a total of 1360 participants; evidence for the effectiveness of exercise-based programs
67.9% of these were classified as acute injuries. Most of to prevent soccer injuries and recommended high-quality
the injuries occurred during the Summer Paralympic studies investigating the best type and intensity of exer-
Games 1992 (37.3%) and 1996 (39.2%). Wheelchair cises. A limitation is that very few studies involving clini-
athletes had the highest injury prevalence (27.8%) fol- cal trials exist within Paralympic sports. Already in 1985,
lowed by CP athletes (24.3%). The most commonly Curtis and Dillon (1985) suggested that preventive strate-
injured body part was the thorax/spine. gies should be taken to decrease injury risks in disability
Athanasopoulos et al. (2009) reported that 64.1% of sports. Ferrara and Davis (1990) reported the importance
all registered injuries at the physiotherapy department of of designing prevention programs including strength,
the Summer Paralympic Games, Athens, 2004, were endurance, and flexibility for disabled athletes, and Curtis
classified as an acute injury. Similar patterns were seen and Black (1999) recommended that warm-up strategies,
in U.S. Paralympic athletes during the 1996 Summer stretching, and strengthening should be included in the
Games, Atlanta, where 67% (170/254) of all soft tissue training. McCormick (1985a) suggested focusing on
injuries among 304 athletes had an acute onset (Nyland strengthening of the legs, improvement of cardiovascular
et al., 2000). Chung et al. (2012) showed that the injury fitness, and adequate equipment to help reduce the injury
IR was significantly higher during competition than rate among disabled skiers. Bernardi et al. (2003) showed
training (5.1/1000 h vs 2.0/1000 h) in elite wheelchair that a high training volume was associated with sports-
fencers. Ferrara et al. (2000) suggested that the nature of related muscle pain in disabled athletes, and monitoring of
competitive events increases the incidence of acute inju- training volume was suggested as part of injury prevention.
ries, and a limitation of some of the reviewed studies Also, the authors of the injury surveillance study during
is that injuries are just reported during competition the 2012 Paralympic Games recommended that injury pre-
(Table 1). In the UEFA injury study of soccer injuries in vention interventions should initially target high risk sports
able-bodied athletes, the authors showed that 57% of the (Willick et al., 2013).
injuries occurred during matches and 43% during train- According to the model that van Mechelen et al.
ing. Overuse injuries were more frequent during the pre- (1992) presented for prevention of sports injuries, the
season, and traumatic injuries were more common first step is to evaluate the extent of the injury problem
during the competitive season (Ekstrand et al., 2011). through injury surveillance. Thereafter, injury risk
A strength of the study by Clarsen et al. (2013), in factors and injury mechanisms could be established, and
which a web-based prospective monitoring of illness and on the basis of this information preventive strategies can
injury in Norwegian elite athletes was performed, is that be introduced. Risk factors for sports injuries are often
injuries were recorded both during training and competi- classified as intrinsic or extrinsic. Intrinsic risk factors

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 Injuries in athletes with disabilities
are related to the athlete, whereas extrinsic risk factors et al., 1985; McCormack et al., 1991), which all should be
are related to the environment. considered as intrinsic risk factors. Burnham et al. (1991)
In disabled athletes, the disability itself could be con- suggested that weakness of the external rotators and shoul-
sidered an intrinsic risk factor (Magno e Silva et al., der adductor muscles can contribute to shoulder impinge-
2013a). For example, during the Paralympic Games ment in these athletes. The problem is often exacerbated
1988, 78% of all lower extremity injuries reported in the because the sitting posture in a wheelchair is characterized
Canadian team occurred in the blind athletes (Burnham by internal rotation of humerus and scapular protraction.
et al., 1991) and during the Paralympic Games 2010, Upper extremity injuries were also the most frequently
injuries from falls were more common in VI Nordic reported during the Summer Paralympic Games 2012, and
skiers (Webborn et al., 2012). Athanasopoulos et al. it has been suggested that future research should put
(2009) suggested that the high incidence of ankle injuries emphasis on understanding injury factors and prevention
in VI athletes may be related to poor proprioception, and strategies of these specific anatomical regions (Derman
it has been stated that postural stability is affected by et al., 2013). Also, the authors of the injury surveillance
vision (Aydog et al., 2006). Orthopedic deformities in the from the Olympic Games 2012 recommend further devel-
foot and knee region are sometimes present in individuals opment of preventative measures tailored for each specific
with CP (Horstmann et al., 2009). Patatoukas et al. sport (Engebretsen et al., 2013).
(2011) showed that CP athletes had a higher percentage Very few of the studies reviewed have discussed
of soft tissue injuries compared with other athletes, and intrinsic or extrinsic risk factors. Ferrara and Davis
the authors suggested that limited range of motion, spas- (1990) recommended physical screening of flexibility,
ticity, and discoordination might cause additional stress strength, and cardiovascular function of all athletes to
to muscles, joints, and tendons. Athanasopoulos et al. determine any deficiencies that might predispose the
(2009) proposed that the greater number of lower extrem- athlete for injury. Also, Reynolds et al. (1994) recom-
ity injuries in athletes with CP may be related to mended pre-event screening of injuries to provide better
increased tensile forces in the lower extremity as a result medical support.
of spasticity and deformities.
Amputee athletes appeared to have a high prevalence Discussion
of injury and pain (Nyland et al., 2000; Bernardi et al.,
2003; Athanasopoulos et al., 2009), and it has been sug- It is apparent that existing studies within the area have
gested that the high number of injuries might depend on poor injury definitions. The methodologies, rate denomi-
altered biomechanics in the lower extremity (Bernardi nators, and populations have varied widely between the
et al., 2003). Athletes with a unilateral amputation may reviewed studies. Few studies are sports and disability
also suffer from injuries in the intact lower limb due to specific, and some studies use cross-disability design,
asymmetrically higher forces during running (Nyland which makes it difficult to determine sports and disabil-
et al., 2000). ity specific risk factors. Many studies use the term
In wheelchair athletes low bone mineral density could wheelchair athlete. However, there are a variety of dis-
be considered as a possible intrinsic risk factor for injury. abilities and classification systems of wheelchair ath-
Osteoporosis occurs in almost every person with SCI, letes, and each disability group may have different
which results in an increase in the incidence of lower movement patterns and performance levels (Patatoukas
extremity fractures (Jiang et al., 2006). McCormack et al., 2011). Magno e Silva et al. (2013b) stated that to
et al. (1991) reported seven fractures among 90 wheel- be able to recognize different risk factors within disabil-
chair athletes. Patatoukas et al. (2011) showed that SCI ity sports, it is important to report etiology and injury
athletes had a significantly higher prevalence of fractures prevalence by disability and sports. Few studies report
compared with other athletes. Four fractures were accurate information on characteristics of the subjects,
reported in ice sledge hockey players during the Winter data collection, and surveys. Only three out of 25 studies
Paralympic Games 2002. A regulation change on protec- included the age range of the athletes studied, and this is
tive equipment and sledge height was implemented a limitation that is suggested to be addressed in future
thereafter, and only one fracture was reported in 2010 studies. Only one of the studies reported that the injury
(Webborn et al., 2012), which should be considered a survey was validated (Ferrara et al., 1992a). The sample
successful prevention work. sizes have sometimes been small, and some studies did
Moreover, wheelchair athletes had a high frequency of not report the specific nature of injury (Table 1). Also,
upper extremity injuries (Burnham et al., 1991; Derman the classification systems of injury have varied between
et al., 2013), and these athletes often rely on their upper studies. For example, Ferrara and Davis (1990) classified
extremities both in their daily life as well as in sports, a minor injury as an injury that caused time loss from
which could cause a high stress on their tissues. The dis- training of 7 days or less, whereas one study include a
ability might also be associated with a seated posture, a blister as an injury (McCormack et al., 1991).
smaller upper extremity musculature, denervated muscu- Few studies report incidence, exposure, and time loss
lature, flaccidity, muscle spasms, and spasticity (Asayama of training due to an injury. In injury epidemiology of

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Fagher & Lexell
able-bodied athletes, time loss of training is a commonly training, load, and exposure. This information could pos-
used parameter to describe severity of injury (Kjaer sibly help coaches, trainers, physicians, and therapists to
et al., 2005). Variations in the definitions and method- understand and reduce risk factors of injuries and to better
ologies used for studies of injuries in Paralympic sports plan training and competition phases. An enhanced
today cause inconsistencies in reported data, and com- knowledge of injury epidemiology could also help
parisons of results are difficult. Present studies just researchers to better understand injury mechanisms and
provide information from short-term surveillance during thereby develop and implement effective injury preven-
competitions, and most of the definitions used are not tion programs. It is therefore recommended that future
adopted for overuse syndromes that develop over time. studies also examine the effects of prevention strategies in
In several sports for able-bodied athletes, consensus athletes with disabilities. And, most importantly, knowl-
statements on definitions and data collection procedures edge in this field could also help athletes to increase their
of sports injuries are available, and it is clear that similar sports performance and improve their quality of life.
consensus is needed within Paralympic sports. In the
future, it is recommended that larger and better designed
studies concerning injury epidemiology are conducted Perspectives
within the area of Paralympic medicine. Standardization
of injury definition, nature of injury, and surveys are The Paralympic Games is currently the world’s second
recommended. Sports and disability specific studies are largest sporting event with regard to the number of par-
preferred, and risk factors should be evaluated. Very few ticipants. Paralympic athletes have become elite in their
studies present information regarding long-term conse- sport, and a consequence of this is increased fitness
quences of an injury in disability sports. Therefore, lon- levels and training time (Vanlandewijck & Thompson,
gitudinal studies following disabled athletes over time 2011). It is well known that participation in sports, espe-
are recommended, which would also allow researchers cially at elite levels, places the athlete at risk for muscu-
to estimate injury IRs based on athlete exposures. Fur- loskeletal injury (Ljungqvist et al., 2009).
thermore, it is important to examine the consequences of Based on the information in this review, it is clear that
an injury upon quality of life. the few existing studies of injuries in Paralympic sports
The injury surveillances conducted by the IPC at the show that overall rates seem to be high and comparable
Paralympic Games 2002, 2010, and 2012 have been very with rates in able-bodied athletes. Epidemiological data
successful and represent a huge step forward in under- regarding the nature of injuries, and sports and disability
standing injuries in Paralympic athletes during competi- risk factors are very limited. Furthermore, few studies
tion. During the Summer Paralympics Games 2012, the have assessed injury prevention strategies. It is also
injury incidence proportion was 17.8 injuries/100 athletes apparent that some of the existing studies have poor
(Willick et al., 2013) compared with the injury rate of 12.9 injury definitions and methodologies. In the future, con-
injuries/100 athletes during the Summer Olympic Games sensus statements on sports injury definitions and data
(Engebretsen et al., 2013). These results suggest that the collection procedures of sports injuries are recom-
injury panoramas today are almost equal in athletes with mended within Paralympic sports.
disabilities compared with able-bodied athletes.
However, there are still very few studies of injury Key words: Disability, epidemiology, paralympic, sports,
incidence in disabled athletes during their normal training wounds and injuries.
season. Further research in this area could include the
development of an international scientific injury surveil-
lance system for athletes with disabilities, along the lines Acknowledgements
with the system used during the Paralympic Games in
Kristina Fagher, MSc, RPT, is a contracted physiotherapist for the
London 2012. With continuous data over several seasons, Swedish Paralympic Women’s Goalball Team. Jan Lexell, MD,
it would be possible to observe the development of spe- PhD, is Chief Medical Officer in The Swedish Sports Organization
cific trends over time and to monitor and assess the type of for the Disabled and The Swedish Paralympic Committee.

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