Comparative Analysis of Injury and Illness Rates Among Team USA Athletes at the Tokyo 2020 Summer Olympic and Paralympic Games

Eric G Post; Malia G Cali; Stephanie C Clark; Kayle E Noble-Taylor; David M Robinson; Ike B Hasley; Emily G Larson; April L McPherson; Travis Anderson; Jonathan T Finnoff; William M Adams

doi:10.1177/23259671241304417

Comparative Analysis of Injury and Illness Rates Among Team USA Athletes at the Tokyo 2020 Summer Olympic and Paralympic Games

Orthop J Sports Med. 2025 Jan 2;13(1):23259671241304417. doi: 10.1177/23259671241304417. eCollection 2025 Jan.

Authors

Eric G Post^{1

2}, Malia G Cali³, Stephanie C Clark⁴, Kayle E Noble-Taylor^{5

6}, David M Robinson⁷, Ike B Hasley⁸, Emily G Larson⁸, April L McPherson^{9

10}, Travis Anderson^{1

2}, Jonathan T Finnoff^{1

2

11}, William M Adams^{1

2

12

13}

Affiliations

¹ Department of Sports Medicine, US Olympic & Paralympic Committee, Colorado Springs, Colorado, USA.
² US Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado, USA.
³ The Steadman Clinic and Steadman Philippon Research Institute, Vail, Colorado, USA.
⁴ Swedish Sports Medicine Fellowship, Rehabilitation and Performance Medicine, Swedish Medical Group, Seattle, Washington, USA.
⁵ Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA.
⁶ Corewell Health Department of Orthopedics, Grand Rapids, Michigan, USA.
⁷ Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
⁸ Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA.
⁹ Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, USA.
¹⁰ Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
¹¹ Department of Physical Medicine and Rehabilitation, University of Colorado, Denver, Colorado, USA.
¹² University of North Carolina at Greensboro, North Carolina, USA.
¹³ School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK.

Abstract

Background: Previous research has reported higher rates of both injury and illness among Paralympic athletes compared with Olympic athletes during the Winter Olympic and Paralympic Games, but no studies have directly compared injury and illness incidence between Olympic and Paralympic athletes competing in a Summer Games.

Purpose: To compare injury and illness rates between Olympic and Paralympic Team USA athletes competing in the Tokyo 2020 Olympic and Paralympic Games.

Study design: Descriptive epidemiology study.

Methods: All injuries and illnesses that occurred among the Team USA athletes competing in the Tokyo 2020 Summer Olympic or Paralympic Games were documented. A total of 701 Team USA athletes (53.6% female) competed in the Tokyo 2020 Summer Olympic Games, across 34 different sports. For the Tokyo 2020 Summer Paralympic Games, a total of 245 athletes (51.6% female) competed across 20 sports. Incidence rates (IRs) per 1000 athlete-days were calculated according to sex, sport, anatomic location, and illness type. IR ratios (IRRs) were calculated to compare IRs between male and female athletes and between Olympic and Paralympic athletes.

Results: Overall, there were no differences in injury incidence (IRR, 1.18; 95% CI, 0.84-1.68) or illness incidence (IRR, 0.68; 95% CI, 0.41-1.15) between Olympic and Paralympic athletes. Male Paralympic athletes were less likely to sustain an illness compared with female Paralympic athletes (IRR, 0.35; 95% CI, 0.11-0.90).

Conclusion: There were no differences in injury or illness rates between Olympic and Paralympic Team USA athletes competing at the Tokyo 2020 Summer Games, contrary to previous comparisons among winter sport athletes. These results challenge the prevailing notion that Summer Paralympic athletes are at greater injury and illness risk, suggesting that factors beyond Olympic or Paralympic Games participation influence health concerns.

Keywords: Olympic; Paralympic; elite sport; epidemiology; illness incidence; injury incidence.