Article Text

Download PDFPDF
Why we should focus on the burden of injuries and illnesses, not just their incidence
  1. Roald Bahr1,2,
  2. Benjamin Clarsen1,
  3. Jan Ekstrand3
  1. 1 Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  2. 2 Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  3. 3 Division of Community Medicine, Department of Medical and Health Sciences, Football Research Group, Linköping University, Linköping, Sweden
  1. Correspondence to Professor Roald Bahr, Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, 0806 Oslo, Norway; roald{at}, roald.bahr{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


More and more sports medicine clinicians are taking an active approach to prevent injury and illness within their team.1–3 The first steps in developing a risk management plan are risk estimation and assessment.4–7 In this phase, the main questions are: what injuries can we expect? Or illnesses? And which are the most serious? Another question is: when is injury risk the greatest? The purpose is to identify which problems need to be focused on in a risk management plan in order to mitigate risk.

These questions can be answered by establishing injury surveillance within the team or by reviewing data from epidemiological studies on teams from a similar level.6 7 However, as a practitioner, you need to know how to interpret such data, whether they are your own or from others.8

The need for precise language to describe the extent of the problem: incidence, severity or burden?

A number of consensus statements have been published to encourage consistency in how injuries are defined and reported in epidemiological studies, initially on cricket (2005, updated in 2016),9 10 followed by football (2006)11 and several other sports such as rugby (2007),12 tennis (2009),13 athletics (2014)14 and aquatic sports (2016).15 In general, these recommend that the rate of injury should be reported as injury incidence, calculated as number of injuries per 1000 hours of exposure. This recommendation has since been followed by the vast majority of surveillance studies, and incidence is typically also the main outcome used to compare sports, genders, age groups and so on. However, we argue that focusing on injury/illness incidence alone may give an incomplete and even erroneous picture of risk.

It should be noted that the consensus statements also recommend that injury severity be reported, generally as the number of days from the date of injury to the date of the player’s return to full participation. …

View Full Text


  • Contributors RB, BC and JE: each wrote sections of the initial draft of the article, which were then discussed and refined by all authors.

  • Funding The Oslo Sports Trauma Research Center has been established through generous grants from the Eastern Norway Regional Health Authority, the International Olympic Committee, the Royal Norwegian Ministry of Culture, Norsk Tipping AS and the Norwegian Olympic and Paralympic Committee & Confederation of Sport. The Football Research Group was established in Linköping, Sweden through grants from UEFA, the Swedish Football Association and the Swedish National Centre for Research in Sports.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice The paper has been corrected since it was published Online First. This paper is a revision of article bjsports-2017-098160: the authors asked for the opportunity to expand their text and references in response to post publication feedback. The BJSM editors sent the revised version for additional peer review. The authors responded to those peer-review comments.