Introduction: To investigate the prevalence, incidence rate (IR) and burden of injuries in elite Australian triathletes over four years of training and competition to assist the identification of future prevention priorities.
Methods: Fifty triathletes (25 females and 25 males, mean age: 24 years ± 3.5) of the Australian national elite squad were prospectively followed for four seasons (2018-2021). Injuries requiring medical attention were prospectively recorded in a centralised database and were further sub-categorised as time-loss or non-time loss injuries. The IR and burden were calculated per 365 athlete-days, with differences in IR between males and females compared using incidence rate ratios (IRR) generated from negative binomial regression modelling.
Results: A total of 266 injuries were reported in 46 athletes, with 61.3% injuries resulting in a period of time-loss. The overall IR was 1.87 (95%CI=1.7-2.8) injuries per 365 athlete–days, and comparable between females (2.1, 95%CI=1.8-2.4) and males (1.7, 95%CI=1.4-2.0) (IRR= 0.82, 95%CI=0.7-1.0, p=0.10). Overall athlete availability was 83.8% (95%CI=83.5-84.0).
The injury sites were comparable between females and males, with injuries most frequently reported at the ankle (15.8%), foot (12.4%), and lower leg (12.0%). Foot injuries accumulated the highest number of days missed from sport (2337 days). Pelvis/buttock (75 days, IQR 6-204) and foot (60, IQR 20-152) injuries had the highest median days of time loss per injury.
The most frequently reported tissue type injury was muscle (n=48, 18.0%) and tendon (n=46, 17.3%) injuries. There were twenty-five bone stress injuries reported, which resulted in the highest number of total days missed from sport (4456 days) of all tissue types. Bone stress injuries resulted in the highest number of median days lost (160 days, IQR 121-208). Females had a 2.7 times higher rate of bone stress injuries compared to males (IRR=2.7, 95%CI=1.1-6.4, p=0.03).
The injury burden was 68.5 days time-loss per 365 days (95%CI=58.8-80.0), with bone stress injuries accounting for almost half of the overall injury burden (32.1 days time-loss per 365 days, 95%CI=21.7-47.5).
Discussion: The majority of medical attention injuries reported in elite triathletes resulted in time-loss. Foot, ankle and lower limb injuries had the highest incidence, however pelvis/buttock and foot injuries were more severe, resulting in the highest number of training and competition days missed. The overall injury rate experienced by male and female triathletes was comparable, however, females demonstrated a significantly higher rate of bone stress injuries compared to male triathletes. Whilst there was a higher incidence of muscle and tendon injuries, bone stress injuries were far more severe than any other injured tissue and had the highest injury burden.
Impact and application to the field:
- •Bone stress injuries were associated with the highest injury burden.
- •The higher rate of bone stress injuries in female triathletes warrants consideration for specific selective prevention strategies.
Conflict of interest statement
My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.