Injury and illness: an analysis of team USA athletes at the 2024 winter youth olympic games | Injury Epidemiology

This is the first known study to describe the characteristics and incidence rates of injuries and illnesses sustained by a single nation’s athlete delegation competing in a Winter Youth Olympic Games. The main findings from this study were (1) injury and illness IRs were greatest among sliding sport athletes (i.e., bobsled, skeleton, and luge), (2) overuse injuries and respiratory illnesses were most common, and (3) while there were no differences in injury or illness IRs between male and female athletes, female athletes sustained all time-loss injuries.

Compared to previous Team USA data from a Summer YOG (426 injuries and 213 illnesses per 1000 athletes) [15], fewer injuries and illnesses were reported at the 2024 Winter YOG (327 injuries and 129 illnesses per 1000 athletes) on a per athlete basis. Higher injury rates from the Summer 2014 YOG were likely due to inclusion of rugby sevens (the only contact team sport) for the first time at a YOG. Rugby sevens was a key driver of injury IRs among Team USA youth athletes at the 2014 YOG, with the rugby team having the largest roster size and contributing to five out of the six time-loss injuries [15].

In the current study, an injury IR of 38 injuries per 1,000 AD was observed, which was higher than previously reported injuries for Team USA youth athletes participating at the Tokyo 2020 Summer Olympic Games (15.7 injuries per 1,000 AD) [22] and Beijing 2022 Winter Olympic Games (14.8 injuries per 1,000 AD) [22]. Athletes at the Winter 2024 YOG also reported higher injury rates than Team USA athletes from the Winter Olympic Games in Beijing 2022 (16.5 injuries per 1,000 AD) [23] and PyeongChang 2018 (2.3 injuries per 1,000 AD) [24]. A potential explanation for the higher injury IRs at the 2024 Winter YOG could be attributed the implementation of the USOPC’s IIS in 2023, which has facilitated an improvement in the accuracy of data reported by clinicians during a Games period [16]. It is possible that the athletes competing for Team USA at the YOG are truly at higher risk for injury compared to other Team USA athletes competing at the Olympic games, but future research is needed using the USOPC’s IIS to better compare rates across various Games periods and athlete populations.

Injury incidence among Team USA athletes at the 2024 Winter YOG was highest among the sliding sports, with bobsled (167 injuries per 1,000 AD), followed by luge (117 injuries per 1,000 AD) and skeleton (100 injuries per 1,000 AD). This is not surprising as sliding sport athletes have been among the most frequently injured athletes at previous Winter Olympic Games [25], including Team USA athletes competing at the Beijing 2022 Olympics (bobsled/skeleton, 17.7 injuries per 1,000 AD; luge, 51.5 injuries per 1,000 AD) [23]. However, these results are in contrast to the sliding sport data from the 2012 Innsbruck Winter YOG, where this sport category ranked among the lowest injury IRs with only 6% of athletes sustaining injuries [12]. Winter sports are unique due to their environment (i.e. competing on ice or snow) and requirement of high-velocity movements using specialized equipment on that terrain. Events such as collisions with the sliding track wall and overturns or ejection from the sled can lead to serious injury [26], including death, as was the case with a luge athlete who was ejected from the track during training at the Vancouver 2010 Winter Olympics [26]. Youth athletes are likely less experienced than their older adult counterparts participating at the senior Olympic Games, which may also contribute to the higher injury IRs observed in these athletes. This may be particularly true for sports using specialized equipment, like bobsled, as they navigate a difficult sliding track.

Respiratory illness was the most common illness reported by Team USA youth athletes during the Winter YOG. This finding is consistent with illness surveillance data from studies of previous Games periods, which has found respiratory illness to consistently be the most common illness type reported by athletes [12,13,14,15, 24]. The percentage of illnesses overall in this study (9.9%) and the percentage of athletes who contracted a respiratory illness (5.9%) was higher than the Beijing 2022 Winter Olympic Games (overall illness, 4%, respiratory illness, 1.4%) [27]. This is likely, in part, due to the mandatory countermeasures (vaccination, masking, contact tracing, etc.) that were in place by the organizing committee, and the concerted effort by staff and athletes to prevent the spread of COVID-19 in Beijing that reduced respiratory illnesses overall [27]. Large-scale sporting events such as the YOG host thousands of athletes and staff from across the world, creating opportunity for the spread of viruses amongst athletes in close contact, such as those within the same delegation or sport. Winter Games also have a higher risk of respiratory agitation with athletes typically training in cold air environments [28]. Travel away from home across five or more time zones has also been shown to increase the risk of illness by 2 to 3 times [29], which certainly could have been a factor for athletes traveling from the USA to South Korea.

Overuse was the most common injury mechanism (17 injuries per 1,000 AD) experienced by athletes, followed closely by direct contact with an object (15 injuries per 1,000 AD). Overuse injuries occur due to repeated submaximal loading of the musculoskeletal system when adequate rest is not available to allow for structural adaptation to take place [1]. Focusing on appropriate load management for elite youth athletes is important as it is a significant risk factor for injury [30]. In 2016, the IOC released a consensus statement summarizing the evidence linking load and injury risk. It includes practical guidelines for managing load in sport, including guidelines for management and prescription of physiological and psychological load during training and competition to promote athlete well-being and mitigate injury risk [31]. Another note for consideration is that youth athletes are still developing both psychologically and physically. Recognizing that elite youth athletes may be undergoing rapid growth and are at various stages of biological maturity in combination with excessive training loads and sport specialization may put them at a greater risk of injury. Training load is a modifiable risk factor; therefore, strategies need to be put in place for load management to ensure balance between load and tissue capacity [31].

In the present analysis, over one quarter (27.3%) of all injuries resulted in time-loss from sport (median 17 days), which is a greater proportion among Team USA youth athletes than previously reported [15]. Interestingly, although there were no differences in injury IRs between male and female athletes, all of the time-loss injuries were reported by female athletes. It is possible that these female athletes sustained more severe injuries, or that they were more likely to report symptoms to healthcare providers due to their injury. Some evidence exists that suggests females are more likely to seek medical attention and utilize health care services than males [32, 33] which may explain why there are more medical encounters noted among female athletes than males [24]. There is also evidence suggesting female athletes at the high school [34] and collegiate level [35, 36] have significantly longer time-loss from sport; therefore, it is not surprising that the female youth athletes in this sample experienced greater time-loss than male athletes.

Strengths and limitations

The present analysis is the first time that Team USA data from a Winter YOG has been presented. The data collection methods utilized by Team USA clinical staff reporting into the newly developed USOPC IIS [16] allowed for the collection of detailed injury and illness information, including type, injury mechanism and onset, anatomical location, and body system affected. Measures of injury and illness severity were also collected by tracking return to sport dates to determine time-loss, rather than relying on an estimation, as in previous data sets published prior to updated IOC recommendations in 2020 [9, 19]. Although collecting actual return to play dates is more difficult, the improved accuracy of the data is valuable for quantifying severity and post-injury and illness return to play timelines in this population.

While this study provided an analysis of surveillance data from Team USA youth athletes, some limitations must be acknowledged. This study included data from a single, large NOC; while this information may be generalizable for other similar size nations, it may not be representative of smaller delegations with less access to resources. Single-delegation analyses can provide a more detailed account of injury and illness rates that are valuable to that specific nation because each country has a diverse set of athletes, resources, and infrastructure. However, interpreting reports from single-nation delegations can also introduce a challenge when comparing to previous studies, as a reduced sample size can be more greatly affected by small changes in the frequency of injuries and illnesses reported. The differences in reporting protocols, particularly surrounding exposure variables (athlete days vs. number of athletes) also makes comparisons between nations and across different Games periods more challenging. As previously noted, single-nation incidence tends to be greater than multi-nation incidence reported during a Games period, due to the challenges inherent to collecting accurate data across multiple nations [37]. While we used our new injury and illness surveillance system to capture data, we are not immune to the limitations of data entry by clinicians, therefore an underreporting of injuries and illnesses is possible. Access to additional information about potential risk factors such as event environmental conditions and athlete training or health and injury history was not available. We also assumed that all athletes were injury- and illness-free when arriving in Gangwon; however, it is possible that some athletes arrived with an existing injury or illness that was obtained prior to the games and carried over into the games period. Lastly, information regarding mental health was reported separately in the electronic medical record out of concern for athlete privacy and therefore, was not included in this analysis. Monitoring mental health conditions is a vital component of providing holistic healthcare and understanding the incidence and interactions of mental health conditions should be included in future investigations.

Clinical implications

Findings from this investigation provide important injury and illness information for medical staff and committees organizing large-scale international youth winter sport competitions. Understanding the risk profiles of high-risk winter sports such as bobsled, luge, and skeleton can help ensure that adequate and appropriate medical personnel are onsite to manage suspected injuries and illnesses, and medical staff are adequately prepared and equipped to respond to medical needs as they arise. It was also identified that there is a continued need for illness prevention strategies and prevention of overuse injuries at future YOG. Effective strategies including hygiene education (hand washing, wearing masks, avoiding crowds, etc.), lifestyle management (travel, nutrition, sleep, etc.), and physical training and psychological load management when preparing for future YOG and other major sporting competitions should be considered and implemented [30]. Lastly, sport governing bodies at the national and international level should utilize surveillance data to better understand the relative risks of sports participation to develop effective strategies for overall optimization of youth athlete health, wellness, and performance.