The aim of this study was to describe, analyze, and evaluate the incidence of injuries and illnesses among athletes competing in the Beijing 2022 Olympic Winter Games. The main findings of this 17-day retrospective study were that 11.3% and 2.8% of the 2897 athletes experienced at least one injury or illness, respectively. This resulted in 11.3 injuries and 2.8 illnesses per 100 athletes during the Games. Furthermore, the characteristics of injuries and illnesses varied greatly according to sport event and athletes’sex.
Injuries in the Olympic sports
The incidence of injuries in the Beijing 2022 Olympics (11%) was slightly lower than those in PyeongChang 2018 (12%)[3] and Sochi 2014 (12%)[2] but comparable to those of Vancouver 2010 (11%)[9] and London 2012 (11%)[10] and slightly more than in Beijing 2008 (10%)[11] and Rio 2016 (8%)[12]. Furthermore, 13.3% of women and 9.5% of men had at least one injury. The injury rate among female athletes was similar to their counterparts in PyeongChang 2018 (13.7%) whereas this rate among male athletes was slightly lower (11.9% in PyeongChang 2018). Injury rates in Beijing 2022 among both female and male athletes were lower than those in Sochi 2014 (14.9% and 13.2%, respectively). Thus, it can be concluded that the ratio of male and female has increased in comparison with previous years. With seven new events in Beijing 2022, including women's single bobsled, short track mixed team relay, mixed team ski jump, freestyle skiing big air (men's and women's), mixed team freestyle skiing aerials, and mixed team snowboarding cross, the proportion of female athletes was increased (45%) and athletes were more evenly distributed between men and women in comparison with past Games. This may have led to an increase in injury rates among female athletes. The frequency of injuries could not be obtained because of a lack of data on the number of athletes participating in each sport. However, the events with the most or least injuries were skating sports, and curling, respectively.
Location and type of injuries
Similar to the 2018 PyeongChang Olympic Winter Games[3] and the 2010 Vancouver Olympic Winter Games[9], the site most frequently injured during Beijing 2022 was the knee (22.1%). In total, 50 of 72 (69.4%) knee injuries occurred among athletes from skating sports, alpine skiing, and ice track. According to previous studies, knee injuries mainly occur in snow sports. The incidence of knee injuries in snow sports was 77.4% in the Pyeongchang Olympic Winter Games[3]. Similarly, Flørenes et al.[13] reported that the knee was the most frequently injured body region among athletes in the World Cup tournament, with incidences of 36% in alpine skiing, 29% in freestyle skiing, and 19% in snowboarding. Interestingly, the incidence of knee injuries was roughly the same for ice and snow sports in Beijing 2022, which can be inferred as a consequence of changes in environmental factors, venue or track design disparities, competition rules, or changes in equipment.
In approximately 60% of injuries during Beijing 2022, strain, impingement, and contusion were diagnosed as the top three injury types. In the 2018 Pyeongchang Olympic Winter Games[3], the top three injury types were contusion, sprain, and laceration, accounting for approximately 28.5%, 13.0%, and 9.8% among all injuries, respectively. We found that skating sports caused the highest number of injuries, regardless of whether the knee was the primary injury location or strain was the primary injury type. Moreover, injuries during competition (n = 95, 91.4%) accounted for the largest proportion in skating sports. High-speed sports, such as short track skating and speed skating, in which multiple athletes participated at the same time, were increasingly competitive and led to a higher risk of injury.
Injury surroundings and severities
Injuries were unevenly distributed between training and competition (33.7% vs. 52.5%), and the results differed from those of PyeongChang 2018 (48% vs. 46%), Sochi 2014 (63% vs. 35%), and Vancouver 2010 (54% vs. 46%). Ice hockey was the only sport in Sochi 2014 and PyeongChang 2018 in which injuries occurred more commonly in competition than in training, as was the case in Beijing 2022.These results correspond with earlier epidemiological findings[14–18]. Ice hockey is a team sport with a lot of physical contact, and its intensity, speed, and likelihood of causing fatigue are much higher in competition than in training, resulting in athletes needing a lot of time for recovery.
In a major sporting event such as the Olympic Games, any injury or illness, even if minor in severity and with no time lost, can lead to performance disorders and prevent athletes from achieving their goals, so they are very careful to avoid injuries. Athletes in Beijing 2022 incurred fewer severe injuries (4.3% of injuries were estimated to result in an absence of more than 7 days) than athletes in PyeongChang 2018 and Sochi 2014 (13% and 16%, respectively). These results are comparable to those of Vancouver 2010; however, there was a high percentage of missing data on injury severity in Vancouver[9]. The vast majority of athletes with an absence of more than 7 days were owing to knee and spinal injuries. As knee and spinal injuries often result in long absences from training and competition, the prevention of spinal cord injury, spinal fracture, and severe knee ligament sprains, including injuries of the anterior cruciate ligament, is important.
EMS of injury
An important task of medical services in sports events is to establish transportation and treatment systems for severely injured athletes. The reported rates of transportation to a hospital by ambulance during the Winter Olympic Games were 1.5% in Calgary 1998, 3.2% in Salt Lake City 2002, and 2.8% in Torino 2006[19–21]. In the Sapporo AWG[22], the rate of athlete transportation was 9.3%. The frequency of ambulance transfer in Beijing 2022 was significantly increased (12.8%, 52 of 406) compared with previous Games. All 52 athletes transported by ambulance were injured and none were transported owing to illness. The most frequently transferred athletes were snowboarders, followed by ice hockey players. These events were covered by an emergency medical system, which ensured that ambulances were available 24 hours a day at each venue to provide appropriate treatment for all transferred athletes. The risk of injury varied for different sporting events; therefore, these data provide a basis for emergency medical treatment at major sporting events.
Illnesses in the Olympic sports
The incidence of illnesses in Beijing 2022 was significantly lower than those of PyeongChang 2018 and Sochi 2014 (2.8% of all athletes affected in Beijing vs. 9% in PyeongChang and 8% in Sochi[2–3]). Furthermore, the PyeongChang illness incidence differed between female and male athletes, with slightly more women (57.5%, 46 of 80) than men (42.5%, 34 of 80) competing but with women in PyeongChang experiencing 61% more illnesses than men. These disproportionate rates have previously been reported in the Rio 2016 Paralympic Games[23] and the 2009 athletics[24] and aquatics[25] world championships.
According to previous reports, respiratory infections have accounted for a high proportion of illnesses in other elite sport events over the years[2–3] [23–31]. However, there were only three cases of respiratory problems in Beijing 2022. A total of 50 illnesses (62.5%) were attributed to dentistry and ophthalmology/otolaryngology. Beijing 2022 were the second Games held amid the COVID-19 pandemic. To prevent the transmission of COVID-19 during the Games, organizers of Beijing 2022 formulated scientifically sound and pragmatic countermeasures. In particular, an innovative “closed loop” system[32] was used; participants and venues were classified according to high, medium, and low risk levels and 12 stringent countermeasures were formulated. These included: a) requiring participants to be fully vaccinated at least 14 days prior to their departure for China; and b) mandatory 21-day quarantine for those not fully vaccinated upon arrival in Beijing. As a result, the incidence of respiratory diseases, such as respiratory infections, declined significantly. We consider that this was also the main reason for the decrease in medical treatment of athletes owing to illnesses during the Beijing 2022 Games.
Reflections
Any type of sports participation involves a certain risk of injury. Whereas it is unrealistic to eliminate all injuries in sports, a reasonable goal is to try to reduce risk without changing the nature of the sport and to look for methods to mitigate health risks and protect the health of athletes. The Beijing 2022 Olympics Winter Games was a great success in that no transmission of COVID-19 infection from the “closed loop” to local communities was detected. As the COVID-19 pandemic continues around the world, such countermeasures also provide a reference for large-scale sporting events in the future.
As for study limitations, some data were missing, which influenced the findings.