Background Olympic wrestling styles can result in various types of soft tissue and musculoskeletal injuries. Head and face skin contusions and lacerations were the most common type of injuries, followed by ligament sprains, muscle strains and upper limb joint subluxations and dislocations. The main mechanisms of injuries are direct trauma, using legs and arms as levers, falling, and twisting; most injuries happen during the standing position when two wrestlers engage for a takedown and collide with their heads and limbs. It’s while performing dangerous actions and some high-risk manoeuvres are forbidden based on current regulations of the United World Wrestling. Recognizing and stopping dangerous actions during wrestling competitions are the responsibility of the referee. We hypothesized that a prompt and proper action of referees to stop dangerous actions and faults could reduce the incidence and severity of wrestling injuries.

Objective To study the potential effect of a proactive and cautious referee practice on reducing the rate and severity of wrestling injuries during international level junior championships.

Design Prospective observational study.

Setting Competitive world-level junior wrestlers.

Participants 768 Junior wrestlers.

Interventions Wrestling referees of 2018 Youth Olympic Games that was held on October 2018 in Buenos Aires were instructed to be extremely careful, prompt and proactive in stopping high-risk and dangerous actions. Data and specifications of injuries among 110 participant wrestlers in 2018 Youth Olympic Games have compared with injuries occurred among 658 wrestlers who competed at 2018 Junior World Championships on September 2018 in Trnava/Slovakia governed by a routine referee practice.

Main outcome measurements Rate, severity, type, location and mechanism of injuries.

Results Rate of wrestling injuries during 2018 Junior world championships and the 2018 Youth Olympic Games were 10.64% and 4.54% respectively.

Conclusions Proactive and cautious actions of wrestling referees to promptly stop dangerous actions has the potential to significantly reduce the rate and severity of injuries in wrestling.