Epidemiology of bone injuries in elite athletics: A prospective 9-year cohort study

Objectives: To describe bone injury patterns in elite track and field athletes. To investigate relationships between bone injury and athlete characteristics to inform future injury prevention strategies. Design: Descriptive epidemiology study. Setting: Elite athletics training centres across the United Kingdom and internationally, observed between 2012 and 2020. Participants: 207 Olympic programme senior track and field athletes. Main outcome measures: Injury number, Incidence, Severity, Burden, Time Loss. Results: There were 78 fractures during the study period. Gradual repetitive bone injuries were the most common type of injury mode. The foot, pelvis and the lumbar spine were the regions with the highest number of bone stress injuries. Stress fractures had a higher burden overall compared to stress reactions. Average return to full training was 67.4 days (+/- 73.1) for stress reactions and 199 (+/- 205.2) days for stress fractures. There was no relationship between bone injury type and age, sex, ethnicity, side dominance or event group. Conclusion: Bone stress injuries in athletics have a high severity and burden warranting continued efforts to prevent their occurrence and optimize management. Age, sex, ethnicity, side dominance and event region do not have any relationship with bone injury occurrence and are therefore unlikely to increase risk in this cohort.