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Epidemiology of imaging-detected bone stress injuries in athletes participating in the Rio de Janeiro 2016 Summer Olympics
  1. Daichi Hayashi1,2,
  2. Mohamed Jarraya1,3,
  3. Lars Engebretsen4,5,6,
  4. Michel D Crema1,7,8,
  5. Frank W Roemer1,9,
  6. Abdalla Skaf10,
  7. Ali Guermazi1
  1. 1 Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine, Boston, Massachusetts, USA
  2. 2 Department of Radiology, Stony Brook University School of Medicine, Stony Brook, New York, USA
  3. 3 Department of Radiology, Mercy Catholic Medical Center, Darby, Pennsylvania, USA
  4. 4 Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
  5. 5 Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
  6. 6 Department of Orthopaedic Surgery, Oslo University Hospital, University of Oslo, Oslo, Norway
  7. 7 Department of Sports Medicine, National Institute of Sports (INSEP), Paris, France
  8. 8 Department of Radiology, Saint-Antoine Hospital, University Paris VI, Paris, France
  9. 9 Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
  10. 10 Department of Radiology, HCor Hospital and ALTA Diagnostic Center (DASA group), São Paulo, Brazil
  1. Correspondence to Dr Daichi Hayashi, Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine, Boston, MA 02118, USA; Daichi.Hayashi{at}


Background Bone stress injuries are common in high-level athletics.

Aim To describe the demographics, frequency and anatomical location of stress injuries (ie, stress reaction and stress fractures) in athletes at the Rio de Janeiro 2016 Summer Olympic Games.

Methods We recorded all sports injuries at the Rio de Janeiro 2016 Summer Olympics reported by the National Olympic Committee (NOC) medical teams and in the polyclinic and medical venues. Imaging was performed through the official IOC clinic within the Olympic Village, using digital X-ray cameras and 3T and 1.5T magnetic resonance (MR) scanners. Images were read centrally and retrospectively by musculoskeletal radiologists with expertise in sports injuries.

Results 11 274 athletes (5089 women (45%), 6185 men (55%)) from 207 NOCs participated in the study. 1101 injuries were reported. Imaging revealed 9 stress fractures (36%) and 16 stress reactions (64%) in 18 female and 7 male athletes (median age 25 years, age range 18–32). Stress injuries were mostly in the lower extremities (84%), particularly tibia (44%) and metatarsals (12%), with two in the lumbar spine (8%). Stress injuries were most common in track and field athletes (44%) followed by volleyball players (16%), gymnastics (artistic) (12%) and other type of sports.

Conclusions Twenty-five bone stress injuries were reported, more commonly in women, mostly in the lower extremities and most commonly in track and field athletes. Our study demonstrates the importance of early imaging with MRI to detect stress reactions before they can progress to stress fractures.

  • bone
  • injury
  • ioc
  • mri
  • olympics
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  • Competing interests Ali Guermazi is the President of Boston Imaging Core Lab (BICL), LLC, and a Consultant to Merck Serono, AstraZeneca, Pfizer, GE Healthcare, OrthoTrophix, Sanofi and TissueGene. Frank Roemer and Michel Cremaare shareholders of BICL, LLC. Lars Engebretsen is a consultant to Arthrex and Smith and Nephew. The remaining authors have no conflicts of interest to disclose.

  • Ethics approval The research was approved by IOC as well as ethics committee of South-Eastern Norway Regional Health Authority (#S-07196C).

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data sharing statement Unpublished data are not available for sharing.

  • Correction notice This article has been corrected since it was published Online First. One affiliation has been corrected.

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