Background Existing studies have reported that female athletes are at increased risk of particular injury types e.g. ACL rupture and bone stress injury, and have reduced risk of others e.g. hamstring injury. Other sport-specific studies have reported that female athletes generally have higher risk of injury in some sports, lower risk in others. No previous study has compared male and female injury rates across a range of summer Olympic sports.

Objective To determine whether male and female athletes experience injuries at different rates within the UK High Performance System.

Design Retrospective cohort study.

Setting UK summer Olympic sports.

Participants 914 athletes (439 female, 475 male).

Interventions There was no intervention.

Main Outcome Measurements Incidence rate ratio (IRR) comparing overall injury rates (as incidence per athlete year) and risk ratio (RR) comparing overall injury burden (training days restricted or unavailable per athlete year) for male and female athletes. The IRR and RR were also compared for injuries in different regions as well as different tissue types.

Results Female athletes had both a greater overall injury rate (females 2.6 injuries per athlete year, males 2.1; IRR 1.23, 95% CI 1.17 to 1.2330, p<0.001) and overall injury burden (females 42.58 days training affected per athlete year, males 35.0; RR 1.211.22, 95% CI 1.201.21 to 1.231.24, p<0.001) than male athletes. Female athletes have a higher risk of lumbar/pelvis, foot and ankle injuries (among others) and a higher risk of superficial/skin, ligament/joint and bone injuries.

Conclusions Female athletes are at greater risk of suffering an initial injury with more subsequent training time-loss than male athletes. The higher risk of ligament/joint and bone injuries supports previous analyses of gender-specific injury rates. Further work is required to determine causal mechanisms so that tailored mitigation strategies can be developed for female and male athletes.