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Injury incidence and prevalence in elite short-course triathletes: a 4-year prospective study
  1. Melissa Leith Crunkhorn1,2,
  2. Liam Anthony Toohey1,3,
  3. Paula Charlton1,4,
  4. Michael Drew1,
  5. Kate Watson5,
  6. Naroa Etxebarria1
  1. 1University of Canberra Research Institute for Sport and Exercise, Canberra, Australian Capital Territory, Australia
  2. 2Queensland Academy of Sport, Nathan, Queensland, Australia
  3. 3AIS Performance, Australian Institute of Sport, Bruce, Australian Capital Territory, Australia
  4. 4Triathlon Australia, Gold Coast, Queensland, Australia
  5. 5Performance Health, Queensland Academy of Sport, Nathan, Queensland, Australia
  1. Correspondence to Mrs Melissa Leith Crunkhorn, University of Canberra, Canberra, ACT 2617, Australia; melissa{at}


Objective To characterise the prevalence, incidence rate (IR) and burden of injuries in elite short-course triathletes over a 4-year training and competition period.

Methods Fifty elite Australian triathletes were prospectively monitored for injury during four consecutive seasons (2018–2021). Injuries requiring medical attention were prospectively recorded and further subcategorised according to time loss. The IR and burden (injury IR×mean injury severity) were calculated per 365 athlete days, with sex differences in IR compared using IR ratios (IRR) from negative binomial regression models.

Results Two hundred and sixty-six injuries were reported in 46 (92.0%) athletes, of which 67.3% resulted in time loss. The injury IR was 1.87 injuries per 365 athlete days (95% CI 1.70 to 2.80), and comparable between sexes (IRR 0.82, 95% CI 0.64 to 1.04, p=0.109). Most injuries (70.7%) were training related. The most frequently injured body sites were the ankle (15.8%), foot (12.4%) and lower leg (12.0%). Bone stress injuries (BSIs) were the most burdensome injury type with 31.38 days of time loss per 365 days (95% CI 24.42 to 38.34). Twenty athletes (40.0%) reported at least one bone stress injury (BSI) (range 0–3). The rate of BSIs in female athletes was three times greater compared with male athletes (IRR 2.99, 95% CI 1.26 to 7.07, p=0.013).

Conclusion Two-thirds of injuries reported in elite short-course triathletes resulted in time loss, with the majority occurring during training activities. Foot, ankle and other lower leg injuries had the highest incidence, with BSIs carrying the highest injury burden. The considerably higher rate of BSI observed in female athletes warrants consideration for future prevention strategies in female triathletes.

  • Epidemiology
  • Sports
  • Athletes
  • Fractures, Stress
  • Sporting injuries

Data availability statement

No data are available.

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  • Contributors All authors contributed to the original concept and design. MLC, LAT and PC conducted data preparation and LAT and MLC performed the analyses. All authors contributed to the editing of the manuscript and have read and approved the final version, and agreed with the order of the presentation of authors. MLC is the guarantor of the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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