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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 Jarraya2,3,
  3. Lars Engebretsen4,5,6,
  4. Michel D Crema2,7,8,
  5. Frank W Roemer2,9,
  6. Abdalla Skaf10,
  7. Ali Guermazi2
  1. 1Department of Radiology, Stony Brook University School of Medicine, Stony Brook, New York, USA
  2. 2Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine, Boston, Massachusetts, USA
  3. 3Department of Radiology, Mercy Catholic Medical Center, Darby, Pennsylvania, USA
  4. 4Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
  5. 5Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
  6. 6Department of Orthopaedic Surgery, Oslo University Hospital, University of Oslo, Oslo, Norway
  7. 7Department of Sports Medicine, National Institute of Sports (INSEP), Paris, France
  8. 8Department of Radiology, Saint-Antoine Hospital, University Paris VI, Paris, France
  9. 9Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
  10. 10Department of Radiology, HCor Hospital and ALTA Diagnostic Center (DASA group), São Paulo, Brazil
  1. Correspondence to Dr Daichi Hayashi, Department of Radiology, Stony Brook University School of Medicine, Stony Brook, New York, 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 ImagingCore Lab (BICL), LLC, and a Consultant to MerckSerono, AstraZeneca, Pfizer, GEHealthcare, OrthoTrophix, Sanofi and TissueGene. Frank Roemer and Michel Cremaare shareholders of BICL, LLC. Lars Engebretsen is a consultant to Arthrex andSmith 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.