Article Text

Incidence and burden of injury at the Tokyo 2020 Paralympic Games held during the COVID-19 pandemic: a prospective cohort study of 66 045 athlete days
  1. Wayne Derman1,2,
  2. Phoebe Runciman1,
  3. Maaike Eken1,
  4. Pieter-Henk Boer3,
  5. Cheri Blauwet4,
  6. Manos Bogdos5,
  7. Guzel Idrisova6,
  8. Esme Jordaan7,8,
  9. James Kissick9,
  10. Philipe LeVan10,
  11. Jan Lexell11,
  12. Fariba Mohammadi12,
  13. Marcelo Patricio13,
  14. Martin Schwellnus2,14,
  15. Nick Webborn15,
  16. Stuart E Willick16,
  17. Kazuyoshi Yagishita17
  1. 1 Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
  2. 2 IOC Research Center, Pretoria, South Africa
  3. 3 Department of Human Movement Science, Cape Peninsula University of Technology, Cape Town, South Africa
  4. 4 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  5. 5 Alzheimer’s Disease Center, Nestor Psychogeriatric Society, Athens, Greece
  6. 6 Sport and Health, Lesgaft National State University of Physical Education, St. Petersburg, Russian Federation
  7. 7 Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
  8. 8 Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
  9. 9 Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
  10. 10 Pôle Médical, Institut National des Sports de l'Expertise et de la Performance, Paris, France
  11. 11 Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden
  12. 12 Department of Sport Medicine, Sport Sciences Research Institute, Tehran, Iran (the Islamic Republic of)
  13. 13 Trauma Observatory, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
  14. 14 Sport, Exercise Medicine and Lifestyle Institute, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
  15. 15 School of Sport and Health Sciences, Loughborough University, Loughborough, UK
  16. 16 Physical Medicine and Rehabilitation, University of Utah Orthopaedic Center, Salt Lake City, Utah, USA
  17. 17 Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Bunkyo-ku, Japan
  1. Correspondence to Professor Wayne Derman, Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa; ewderman{at}


Objective To describe the epidemiology of injuries at the Tokyo 2020 Paralympic Games, including injuries sustained in the new sports of badminton and taekwondo.

Methods Injury data were obtained daily via the established web-based injury and illness surveillance system (WEB-IISS; 81 countries, 3836 athletes) and local organising committee medical facilities (81 countries, 567 athletes). Univariate unadjusted incidences (injuries per 1000 athlete days with 95% CIs), injury proportion (IP, %) and injury burden (days lost per 1000 athlete days) are reported.

Results A total of 4403 athletes (1853 women, 2550 men) from 162 countries were monitored prospectively during the 3-day pre-competition and 12-day competition periods (66 045 athlete days). 386 injuries were reported in 352 athletes (IP=8.0%) with an incidence of 5.8 per 1000 athlete days (95% CI 5.3 to 6.5). Football 5-a-side (17.2), taekwondo (16.0), judo (11.6) and badminton (9.6) had the highest incidence. There was a higher incidence of injuries in the pre-competition period than in the competition period (7.5 vs 5.4; p=0.0053). Acute (sudden onset) injuries and injuries to the shoulder (0.7) and hand/fingers (0.6) were most common. Injury burden was 10.9 (8.6–13.8), with 35% of injuries resulting in time loss from training and competition.

Conclusion Compared with previous Paralympic Games, there was a reduction in injury incidence but higher injury burden at the Tokyo 2020 Paralympic Games. The new sports of taekwondo and badminton had a high injury incidence, with the highest injury burden in taekwondo, compared with other sports. These findings provide epidemiological data to inform injury prevention measures for high-risk sports.

  • Athletes
  • Covid-19
  • Disabled Persons

Data availability statement

No data are available.

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  • EDI statement This study was conducted exclusively in athletes with disability, who are classified as a marginalised group, and was inclusive of all athletes participating at the Tokyo 2020 Paralympic Games. The author team is balanced. The researchers represent different genders from both Northern and Southern hemispheres and different socioeconomic status countries. Furthermore, the research group includes individuals from marginalised groups, as well as perspectives from multiple disciplines.

  • Contributors All authors have contributed to the development, application and write-up of the study.

    WD stands as guarantor.

  • Funding Funding for this study was provided by the IOC Research Centre South Africa grant and International Paralympic Committee research support.

  • Competing interests All authors have completed and submitted COI forms. WD is an associate editor of BJSM IPHP editions.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.