Abstract
Background
Injury and illness surveillance is essential for understanding the relative risks of sports participation to develop effective strategies to optimize athlete health, wellness, and performance. Epidemiological studies examining injuries and illnesses among Team USA youth athletes are limited, particularly among athletes competing in Winter sports. The purpose of this study was to characterize the injury and illness incidence rate among Team USA athletes participating in the 2024 Winter Youth Olympic Games (YOG).
Methods
Injuries and illnesses among 101 Team USA youth athletes (40.6% female; age, 17 ± 1 years) were prospectively documented. Injury and illness prevalence, and incidence rate (IR) per 1,000 athlete-days (AD), and incidence rate ratios (IRR) were calculated with accompanying 95% confidence intervals ([95% CI]).
Results
Nineteen (18.8%) Team USA athletes reported at least one injury during the 2024 Winter YOG (38.0 [26.1, 53.3] injuries per 1,000 AD). Injury IR was highest among athletes competing in bobsled (166.7 [54.1, 388.9] injuries per 1,000 AD), and overuse was the most common mechanism of injury (17.3 [9.7, 28.5] injuries per 1,000 AD) among all athletes. There were no differences in injury IRs between male and female athletes (IRR [95%CI], 1.6 [0.7, 3.3]), but female athletes reported all time-loss injuries. Ten (9.9%) athletes reported at least one illness (15.0 [8.0, 26.5] per 1,000 AD), with respiratory illness (6%) being the most common type (6.9 [2.5, 15.0] per 1,000 AD).
Conclusion
This study highlights the need for focused efforts for injury and illness prevention for youth female athletes and athletes participating in high-risk sliding sports. Additionally, consideration for implementation of respiratory illness mitigation measures and load management strategies at and leading up to future competitions for youth athletes is key.
Supplementary Information
The online version contains supplementary material available at 10.1186/s40621-025-00600-1.
Keywords: Elite performance, Epidemiology, Injury, Illness, Olympics
Introduction
An estimated 60 million children in the United States participate in organized sports annually [1]. Despite the well-established positive physical and psychological health benefits of sport participation, training and competing in sport also brings the risk of injury and/or illness, especially for youth engaged in highly competitive sport environments [2, 3]. Among youth athletes in the United States, there are approximately 12 million documented sport-related injuries annually [3, 4]. In addition to the injury and illness burden on the athlete, which can have significant short- and long-term consequences on health, wellness, and performance [5], the larger economic burden of these events cannot be neglected [6–8].
Events such as the European Youth Olympic Festival and Youth Olympic Games (YOG) highlight the growing trend toward the professionalization and specialization of competitive sport at a young age. Since 2010, the YOG has taken place every 2 years (alternating winter and summer sports) hosting thousands of young elite athletes. Similar to the Olympic Games, winter athletes compete in sports such as ice hockey, sliding sports (bobsled, skeleton, luge), figure and short track speed skating, snowboard, and various skiing disciplines (alpine, freestyle, cross-country,) at the YOG. In 2024, the YOG was hosted in Gangwon, South Korea, with 1,802 athletes (50% female) from 78 National Organizing Committees (NOC) participating in sporting activities. In 2008, the International Olympic Committee (IOC) began implementing injury and illness surveillance programs at all Olympic Games (including the YOG) to better understand injury and illness patterns during the Games [9]. Injury rates have been reported from previous Summer YOG (2014 Nanjing Games, 207.1 injuries and 25.3 illnesses per 1000 athletes [10]; 2018 Buenos Aires Games, 15.5 injuries and 8.4 illnesses per 100 athletes [11]) and Winter YOG (2012 Innsbruck Games, 108.7 injuries and 84.3 illnesses per 1000 athletes [12]; 2016 Lillehammer Games, 9.5 injuries and 7.2 illnesses per 100 athletes [13]; 2020 Lausanne Games, 11.7 injuries and 8.6 illnesses per 100 athletes [14]). However, understanding of the injury and illness risk among a single nation’s delegation competing in a YOG remains limited with only one known study reporting on the risks of Team USA athletes competing in the 2014 Summer YOG (426 injuries and 213 illnesses per 1000 athletes) [15]. While there is utility in capturing global injury and illness rates during international competition, understanding the athlete’s risk among a single delegation allows for more targeted approaches toward prevention.
Due to the inherent limitations of collecting injury and illness epidemiological data from the medical representatives of numerous NOCs during a Games, information reported from a single delegation’s injury and illness surveillance system can provide more detailed and accurate data on both injury and illness rates and athlete exposure [16]. While previous studies have described the incidence of injury and illness in elite youth athletes participating at the YOG using data collected across nations by the IOC [10–15, 17, 18], to our knowledge no studies have reported data from a single delegation during a Winter YOG. Therefore, the aim of this study was to describe injury and illness characteristics, including sex and timing (pre-competition, competition, post-competition) comparisons, among Team USA athletes participating in the 2024 Winter YOG in Gangwon, South Korea.
Methods
This descriptive epidemiological study evaluated findings from the United States Olympic & Paralympic Committee’s (USOPC) Injury and Illness Surveillance (IIS) system during the 2024 Winter YOG, held in Gangwon, South Korea. The development and implementation of the USOPC’s IIS system has been previously described in detail [16]. This study was approved by the Institutional Review Board at the University of North Carolina at Greensboro (IRB-FY22-218).
Equity, diversity, and inclusion statement
Data for this study were reported from the diverse population of elite youth athletes competing for Team USA at the 2024 Winter YOG in Gangwon, South Korea. Athletes were provided access to required medical resources regardless of their individual backgrounds and experiences. The research study team consists of a diverse, balanced group of expert clinicians and researchers (42% female; 17% physician; 33% early career investigator).
Patient and public involvement
While no Team USA youth athletes competing in the 2024 Winter YOG were directly involved in creating the research questions or determining outcomes of interest for this study, this study was reviewed and approved by the Research Review Committee at the USOPC. The USOPC Research Review Committee is a diverse and interdisciplinary group of Olympic and Paralympic athlete representatives, sports medicine clinicians, mental health providers, sport physiologists, sport nutritionists, strength and conditioning coaches, national sport governing body representatives, and legal representatives. Authors from this study who were also members of the Research Review Committee recused themselves from review and approval voting of this study proposal.
Data collection
Injuries and illnesses (new, recurrent, or exacerbation of pre-existing conditions) among Team USA youth athletes during the 2024 Winter YOG were documented by credentialed Team USA healthcare providers in the USOPC IIS system. It was assumed that all athletes were injury- and illness-free upon arrival to Gangwon. To capture the full duration of time that Team USA youth athletes were in Gangwon for competition and training, and therefore at risk for developing an injury or illness, medical encounters from the pre- and post-competition period were also included in this study. Thus, medical encounters included in this study occurred across an 11-day pre-competition period prior to the Opening Ceremony (January 19, 2024), the 12-day competition period, and a 3-day post-competition period after the Closing Ceremony (February 1, 2024).
Definition of illness and injury
The USOPC IIS system records injury and illness details according to the 2020 IOC Consensus Statement for recording and reporting of sport epidemiological data [19]. The USOPC IIS system defines injuries as “tissue damage or other derangement of normal physical function due to participation in sports, that requires evaluation by a healthcare provider and results in a diagnosis.” [16] Illnesses are defined as “a physical health-related complaint or disorder experienced by an athlete, that requires evaluation by a healthcare provider and results in a diagnosis.” [16] Within the USOPC IIS, each reported illness and injury is assigned a diagnosis using the Orchard Sports Injury and Illness Classification System (OSIICS v14.0) [20].
Calculation of athlete exposure and time-loss
Athlete travel and accommodation records were obtained from the USOPC and used to determine athlete exposure by calculating the number of days an individual athlete was in Gangwon during the Games. The total number of days that each athlete was in Gangwon were summed to determine the total number of athlete-days (AD), both within the total athlete sample and within each subgroup of interest (i.e., by sex, sport, and Games period). These AD were used as the exposure for calculating injury and illness incidence rates. Return to sport dates were tracked to determine time-loss from sport, which served as the primary measure of injury and illness severity.
Statistical analysis
The total number of Team USA athletes participating in the 2024 Winter YOG, total number of AD, frequency of injuries and illnesses, and sports represented were summarized using descriptive statistics. Incidence rate (IR) was calculated per 1,000 AD for both injury and illness. Injury and illness IR was also calculated by sex (male, female), sport, timing within the Games (pre-competition period, competition period, post-competition period), mechanism, onset, setting (training, competition, peri-competition (warm-up or cool down), outside of primary sport), anatomic location or body system, and illness type. Incidence rate ratios (IRR) were calculated to compare injury and illness IR based on sex and timing within the Games (pre-competition period, competition period, post-competition period). Confidence intervals [95%CI] were calculated for all IRs and IRRs. Analyses were performed using R statistical software (Version 4.3.2, R Foundation for Statistical Computing, Vienna, Austria) and IR, IRR, and 95% CIs were calculated as described above using the epiR statistical package [21].
Results
A total of 101 athletes (female, 40.6%; age, 17 ± 1 year) competed for Team USA across 14 different sport disciplines (Fig. 1) at the 2024 Winter YOG.
Fig. 1.
Injury and illness incidence by sport for Team USA athletes competing at the 2024 Winter Youth Olympic Games (YOG). The dashed line represents the overall injury and illness incidence rates for all sports. Athlete days, AD
Injury incidence rates overall, by sex, sport, and anatomic location
Approximately 1 in 5 (18.8%) Team USA athletes reported at least one injury during the Games period with an overall injury IR of 38 [95%CI: 26.1, 53.3] per 1,000 AD. There were no differences in injury IRs between male and female athletes (IRR[95%CI], 1.6 [0.7, 3.3]) (Table 1). Injury IR was highest in sliding sports (bobsled, luge, skeleton), with the highest IRs observed in bobsled (166.7 [54.1, 388.9] per 1,000 AD), followed by luge (116.9 [53.5, 221.9] per 1,000 AD), and skeleton (100 [20.6, 292.2] per 1,000 AD) (Fig. 1). When examining injury by anatomic location, injury IR was greatest in the lumbar spine (6.9 [2.5, 15.0] per 1,000 AD), followed by the head and ankle (both: 4.6 [1.3, 11.8] per 1,000 AD), and then shoulder, knee, and thoracic spine (all: 3.5 [0.7, 10.1] per 1,000 AD) (Supplemental Table 1).
Table 1.
Injury and illness incidence overall and by sex for Team USA athletes competing at the 2024 Winter Youth Olympic Games (YOG)
| Number of Athletes Competing | Number of ADs | Number of Injuries | Number of Athletes with Injury | Number of Illnesses | Number of Athletes with Illness | Injury Incidence Per 1000 ADs | 95% CI | Illness Incidence per 1000 ADs | 95% CI | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Lower Limit | Upper Limit | Lower Limit | Upper Limit | |||||||||
| Overall | 101 | 869 | 33 | 19 (18.8%) | 13 | 10 (9.9%) | 38 | 26.1 | 53.3 | 15 | 8.0 | 25.6 |
| Male | 60 | 516 | 16 | 10 (16.7%) | 7 | 5 (8.3%) | 31 | 17.7 | 50.4 | 13.6 | 5.5 | 28 |
| Female | 41 | 353 | 17 | 9 (21.9%) | 6 | 5 (12.2%) | 48.2 | 28.1 | 77.1 | 17 | 6.2 | 37 |
Athlete days, AD; Confidence Interval, CI
Injury incidence rates by timing, setting, mechanism, and time-loss
Reported injuries most often occurred during training (19.6 [11.4, 31.3] per 1,000 AD) followed by competitions (11.5 [5.5, 21.2] per 1,000 AD) (Table 2). Most (81.8%) injuries presented as new injuries (31.1 [20.5, 45.2] per 1,000 AD) during the games and the majority (60.6%) had a sudden onset (23 [14.1, 35.5] per 1,000 AD). There were no differences in injury IRs when comparing the pre-competition period to the competition period (IRR[95%CI], 1.3 [0.4, 3.4]). The most common mechanism of injury was overuse, representing almost half (45.5%) of all injuries reported by Team USA youth athletes (17.3 [9.7, 28.5] per 1,000 AD), followed by direct contact with an object (15.0 [8.0, 25.6] per 1,000 AD). Over 1 in 4 (27.3%) injuries resulted in time-loss from sport (median [IQR], 17 [14–22] days missed from training and competition), with all time-loss injuries being reported among female athletes (Table 3).
Table 2.
Injury incidence by presentation, setting, timing, and mechanism for Team USA athletes competing at the 2024 Winter Youth Olympic Games (YOG)
| Total Number of Injuries | Number of Athletes with an Injury | Number of ADs | Percentage of Athletes with an Injury | Injury Incidence Per 1000 ADs | 95% CI | ||
|---|---|---|---|---|---|---|---|
| Lower Limit | Upper Limit | ||||||
| Presentation | |||||||
| New | 27 | 16 | - | 15.84% | 31.1 | 20.5 | 45.2 |
| Recurrent | 1 | 1 | - | 0.99% | 1.2 | 0 | 6.4 |
| Exacerbation | 5 | 4 | - | 3.96% | 5.8 | 1.9 | 13.4 |
| Unknown | 0 | 0 | - | 0.00% | 0 | 0 | 4.2 |
| Setting | |||||||
| Competition | 10 | 4 | - | 3.96% | 11.5 | 5.5 | 21.2 |
| Training | 17 | 12 | - | 11.88% | 19.6 | 11.4 | 31.3 |
| Peri-competition | 0 | 0 | - | 0.00% | 0 | 0 | 4.2 |
| Outside of primary sport | 1 | 1 | - | 0.99% | 1.2 | 0 | 6.4 |
| Unknown, or not specific | 5 | 3 | 2.97% | 5.8 | 1.9 | 13.4 | |
| Timing within Games | |||||||
| Pre-opening ceremony | 5 | 5 | 100 | 4.95% | 50 | 16.2 | 116.7 |
| Competition period | 28 | 16 | 726 | 15.84% | 38.6 | 25.6 | 55.7 |
| Post-closing ceremony | 0 | 0 | 43 | 0.00% | 0 | 0 | 85.8 |
| Mode of Onset | |||||||
| Sudden | 20 | 10 | -- | 9.90% | 23 | 14.1 | 35.5 |
| Gradual | 11 | 9 | -- | 8.91% | 12.7 | 6.3 | 22.7 |
| Mixed | 0 | 0 | -- | 0.00% | 0 | 0 | 4.2 |
| Unknown | 2 | 1 | -- | 0.99% | 2.3 | 0.3 | 8.3 |
| Mechanism | |||||||
| Overuse | 15 | 11 | -- | 10.89% | 17.3 | 9.7 | 28.5 |
| Acute non-contact | 2 | 2 | -- | 1.98% | 2.3 | 0.3 | 8.3 |
| Direct contact (athlete) | 1 | 1 | -- | 0.99% | 1.2 | 0 | 6.4 |
| Direct contact (object) | 13 | 6 | -- | 5.94% | 15 | 8 | 25.6 |
| Following contact (athlete) | 0 | 0 | -- | 0.00% | 0 | 0 | 4.2 |
| Following contact (object) | 2 | 1 | -- | 0.99% | 2.3 | 0.3 | 8.3 |
Athlete days, AD; Confidence Interval, CI
Table 3.
Time-loss injuries and illnesses reported by Team USA athletes competing at the 2024 Winter Youth Olympic Games (YOG)
| Injury | Illness | |||
|---|---|---|---|---|
| N | % or [IQR] | N | % or [IQR] | |
| Time-Loss | ||||
| Yes | 9 | 27.3% | 1 | 7.7% |
| No | 24 | 72.7% | 12 | 92.3% |
| Days Lost | ||||
| 1 to 7 days | 1 | 11.1% | 0 | 0% |
| 8 to 28 days | 8 | 88.9% | 1 | 100% |
| >28 days | 0 | 0% | 0 | 0% |
| Median Number of Days Lost | 17 | [14–22] | 18 | - |
Athlete days, AD; Confidence Interval, CI; Interquartile Range, IQR
Illness incidence rates overall, by sex and sport
There were 13 total illnesses reported during the Games, with approximately 1 in 10 (9.9%) Team USA athletes reporting at least one illness. The overall reported illness IR was 15 [8.0, 25.6] per 1,000 AD. There were no differences in illness IRs between male and female athletes (IRR [95%CI], 1.3 [0.4, 4.4]) (Table 1). Illness IR was highest in bobsled (133.3 [36.3, 341.4] per 1,000 AD), followed by curling (69.0 [18.8, 176.6] per 1,000 AD), and skeleton (66.7 [8.1, 240.8] per 1,000 AD) (Fig. 1).
Illness incidence rates by body system, timing, and time-loss
All 13 of the reported illnesses took place during the competition period (17.9 [9.5, 30.6] per 1,000 AD) (Table 4). Respiratory illnesses were the most common illness type experienced by Team USA athletes, with 5.9% of all athletes reporting at least one respiratory illness during the Games (6.9 [2.5, 15.0] per 1,000 AD) (Table 5). Almost all (92.3%) illnesses reported during YOG were new in presentation (13.8 [7.1, 24.1] per 1,000 AD) (Table 4), and there was only one illness (7.7%) (respiratory system) that resulted in time-loss, with 18 days lost from sport (Table 3).
Table 4.
Illness incidence based on presentation and timing for Team USA athletes competing at the 2024 Winter Youth Olympic Games (YOG)
| Total Number of Illnesses | Number of Athletes with an Illness | Number of ADs | Percentage of Athletes with an Illness | Illness Incidence Per 1000 ADs | 95% CI | |||
|---|---|---|---|---|---|---|---|---|
| Lower Limit | Upper Limit | |||||||
| Presentation | ||||||||
| New | 12 | 10 | - | 9.90% | 13.8 | 7.1 | 24.1 | |
| Recurrent | 0 | 0 | - | 0.00% | 0 | 0 | 4.2 | |
| Exacerbation | 0 | 0 | - | 0.00% | 0 | 0 | 4.2 | |
| Unknown | 1 | 1 | - | 0.99% | 1.2 | 0 | 6.4 | |
| Timing | ||||||||
| Pre-opening ceremony | 0 | 0 | 100 | 0.00% | 0 | 0 | 36.9 | |
| Competition period | 13 | 10 | 726 | 9.90% | 17.9 | 9.5 | 30.6 | |
| Post-closing ceremony | 0 | 0 | 43 | 0.00% | 0 | 0 | 85.8 | |
Athlete days, AD; Confidence Interval, CI
Table 5.
Illness incidence by affected body system for Team USA athletes competing at the 2024 Winter Youth Olympic Games (YOG)
| Body System | Total Number of Illnesses | Number of Athletes with an Illness | Percentage of Athletes with an Illness | Illness Incidence Per 1000 ADs | 95% CI | |
|---|---|---|---|---|---|---|
| Lower Limit | Upper Limit | |||||
| Cardiovascular | 0 | 0 | 0.00% | 0 | 0 | 4.2 |
| Dental | 0 | 0 | 0.00% | 0 | 0 | 4.2 |
| Dermatological | 0 | 0 | 0.00% | 0 | 0 | 4.2 |
| Endocrinological | 0 | 0 | 0.00% | 0 | 0 | 4.2 |
| Gastrointestinal | 2 | 2 | 1.98% | 2.3 | 0.3 | 8.3 |
| Genitourinary | 1 | 1 | 0.99% | 1.2 | 0 | 6.4 |
| Hematologic | 0 | 0 | 0.00% | 0 | 0 | 4.2 |
| Musculoskeletal | 0 | 0 | 0.00% | 0 | 0 | 4.2 |
| Neurological | 0 | 0 | 0.00% | 0 | 0 | 4.2 |
| Ophthalmological | 0 | 0 | 0.00% | 0 | 0 | 4.2 |
| Otological | 0 | 0 | 0.00% | 0 | 0 | 4.2 |
| Psychiatric | 0 | 0 | 0.00% | 0 | 0 | 4.2 |
| Respiratory | 6 | 6 | 5.94% | 6.9 | 2.5 | 15 |
| Thermoregulatory | 0 | 0 | 0.00% | 0 | 0 | 4.2 |
| Multiple systems | 4 | 4 | 3.96% | 4.6 | 1.3 | 11.8 |
| Not specific | 0 | 0 | 0.00% | 0 | 0 | 4.2 |
Athlete days, AD; Confidence Interval, CI
Discussion
This is the first known study to describe the characteristics and incidence rates of injuries and illnesses sustained by a single nation’s athlete delegation competing in a Winter Youth Olympic Games. The main findings from this study were (1) injury and illness IRs were greatest among sliding sport athletes (i.e., bobsled, skeleton, and luge), (2) overuse injuries and respiratory illnesses were most common, and (3) while there were no differences in injury or illness IRs between male and female athletes, female athletes sustained all time-loss injuries.
Compared to previous Team USA data from a Summer YOG (426 injuries and 213 illnesses per 1000 athletes) [15], fewer injuries and illnesses were reported at the 2024 Winter YOG (327 injuries and 129 illnesses per 1000 athletes) on a per athlete basis. Higher injury rates from the Summer 2014 YOG were likely due to inclusion of rugby sevens (the only contact team sport) for the first time at a YOG. Rugby sevens was a key driver of injury IRs among Team USA youth athletes at the 2014 YOG, with the rugby team having the largest roster size and contributing to five out of the six time-loss injuries [15].
In the current study, an injury IR of 38 injuries per 1,000 AD was observed, which was higher than previously reported injuries for Team USA youth athletes participating at the Tokyo 2020 Summer Olympic Games (15.7 injuries per 1,000 AD) [22] and Beijing 2022 Winter Olympic Games (14.8 injuries per 1,000 AD) [22]. Athletes at the Winter 2024 YOG also reported higher injury rates than Team USA athletes from the Winter Olympic Games in Beijing 2022 (16.5 injuries per 1,000 AD) [23] and PyeongChang 2018 (2.3 injuries per 1,000 AD) [24]. A potential explanation for the higher injury IRs at the 2024 Winter YOG could be attributed the implementation of the USOPC’s IIS in 2023, which has facilitated an improvement in the accuracy of data reported by clinicians during a Games period [16]. It is possible that the athletes competing for Team USA at the YOG are truly at higher risk for injury compared to other Team USA athletes competing at the Olympic games, but future research is needed using the USOPC’s IIS to better compare rates across various Games periods and athlete populations.
Injury incidence among Team USA athletes at the 2024 Winter YOG was highest among the sliding sports, with bobsled (167 injuries per 1,000 AD), followed by luge (117 injuries per 1,000 AD) and skeleton (100 injuries per 1,000 AD). This is not surprising as sliding sport athletes have been among the most frequently injured athletes at previous Winter Olympic Games [25], including Team USA athletes competing at the Beijing 2022 Olympics (bobsled/skeleton, 17.7 injuries per 1,000 AD; luge, 51.5 injuries per 1,000 AD) [23]. However, these results are in contrast to the sliding sport data from the 2012 Innsbruck Winter YOG, where this sport category ranked among the lowest injury IRs with only 6% of athletes sustaining injuries [12]. Winter sports are unique due to their environment (i.e. competing on ice or snow) and requirement of high-velocity movements using specialized equipment on that terrain. Events such as collisions with the sliding track wall and overturns or ejection from the sled can lead to serious injury [26], including death, as was the case with a luge athlete who was ejected from the track during training at the Vancouver 2010 Winter Olympics [26]. Youth athletes are likely less experienced than their older adult counterparts participating at the senior Olympic Games, which may also contribute to the higher injury IRs observed in these athletes. This may be particularly true for sports using specialized equipment, like bobsled, as they navigate a difficult sliding track.
Respiratory illness was the most common illness reported by Team USA youth athletes during the Winter YOG. This finding is consistent with illness surveillance data from studies of previous Games periods, which has found respiratory illness to consistently be the most common illness type reported by athletes [12–15, 24]. The percentage of illnesses overall in this study (9.9%) and the percentage of athletes who contracted a respiratory illness (5.9%) was higher than the Beijing 2022 Winter Olympic Games (overall illness, 4%, respiratory illness, 1.4%) [27]. This is likely, in part, due to the mandatory countermeasures (vaccination, masking, contact tracing, etc.) that were in place by the organizing committee, and the concerted effort by staff and athletes to prevent the spread of COVID-19 in Beijing that reduced respiratory illnesses overall [27]. Large-scale sporting events such as the YOG host thousands of athletes and staff from across the world, creating opportunity for the spread of viruses amongst athletes in close contact, such as those within the same delegation or sport. Winter Games also have a higher risk of respiratory agitation with athletes typically training in cold air environments [28]. Travel away from home across five or more time zones has also been shown to increase the risk of illness by 2 to 3 times [29], which certainly could have been a factor for athletes traveling from the USA to South Korea.
Overuse was the most common injury mechanism (17 injuries per 1,000 AD) experienced by athletes, followed closely by direct contact with an object (15 injuries per 1,000 AD). Overuse injuries occur due to repeated submaximal loading of the musculoskeletal system when adequate rest is not available to allow for structural adaptation to take place [1]. Focusing on appropriate load management for elite youth athletes is important as it is a significant risk factor for injury [30]. In 2016, the IOC released a consensus statement summarizing the evidence linking load and injury risk. It includes practical guidelines for managing load in sport, including guidelines for management and prescription of physiological and psychological load during training and competition to promote athlete well-being and mitigate injury risk [31]. Another note for consideration is that youth athletes are still developing both psychologically and physically. Recognizing that elite youth athletes may be undergoing rapid growth and are at various stages of biological maturity in combination with excessive training loads and sport specialization may put them at a greater risk of injury. Training load is a modifiable risk factor; therefore, strategies need to be put in place for load management to ensure balance between load and tissue capacity [31].
In the present analysis, over one quarter (27.3%) of all injuries resulted in time-loss from sport (median 17 days), which is a greater proportion among Team USA youth athletes than previously reported [15]. Interestingly, although there were no differences in injury IRs between male and female athletes, all of the time-loss injuries were reported by female athletes. It is possible that these female athletes sustained more severe injuries, or that they were more likely to report symptoms to healthcare providers due to their injury. Some evidence exists that suggests females are more likely to seek medical attention and utilize health care services than males [32, 33] which may explain why there are more medical encounters noted among female athletes than males [24]. There is also evidence suggesting female athletes at the high school [34] and collegiate level [35, 36] have significantly longer time-loss from sport; therefore, it is not surprising that the female youth athletes in this sample experienced greater time-loss than male athletes.
Strengths and limitations
The present analysis is the first time that Team USA data from a Winter YOG has been presented. The data collection methods utilized by Team USA clinical staff reporting into the newly developed USOPC IIS [16] allowed for the collection of detailed injury and illness information, including type, injury mechanism and onset, anatomical location, and body system affected. Measures of injury and illness severity were also collected by tracking return to sport dates to determine time-loss, rather than relying on an estimation, as in previous data sets published prior to updated IOC recommendations in 2020 [9, 19]. Although collecting actual return to play dates is more difficult, the improved accuracy of the data is valuable for quantifying severity and post-injury and illness return to play timelines in this population.
While this study provided an analysis of surveillance data from Team USA youth athletes, some limitations must be acknowledged. This study included data from a single, large NOC; while this information may be generalizable for other similar size nations, it may not be representative of smaller delegations with less access to resources. Single-delegation analyses can provide a more detailed account of injury and illness rates that are valuable to that specific nation because each country has a diverse set of athletes, resources, and infrastructure. However, interpreting reports from single-nation delegations can also introduce a challenge when comparing to previous studies, as a reduced sample size can be more greatly affected by small changes in the frequency of injuries and illnesses reported. The differences in reporting protocols, particularly surrounding exposure variables (athlete days vs. number of athletes) also makes comparisons between nations and across different Games periods more challenging. As previously noted, single-nation incidence tends to be greater than multi-nation incidence reported during a Games period, due to the challenges inherent to collecting accurate data across multiple nations [37]. While we used our new injury and illness surveillance system to capture data, we are not immune to the limitations of data entry by clinicians, therefore an underreporting of injuries and illnesses is possible. Access to additional information about potential risk factors such as event environmental conditions and athlete training or health and injury history was not available. We also assumed that all athletes were injury- and illness-free when arriving in Gangwon; however, it is possible that some athletes arrived with an existing injury or illness that was obtained prior to the games and carried over into the games period. Lastly, information regarding mental health was reported separately in the electronic medical record out of concern for athlete privacy and therefore, was not included in this analysis. Monitoring mental health conditions is a vital component of providing holistic healthcare and understanding the incidence and interactions of mental health conditions should be included in future investigations.
Clinical implications
Findings from this investigation provide important injury and illness information for medical staff and committees organizing large-scale international youth winter sport competitions. Understanding the risk profiles of high-risk winter sports such as bobsled, luge, and skeleton can help ensure that adequate and appropriate medical personnel are onsite to manage suspected injuries and illnesses, and medical staff are adequately prepared and equipped to respond to medical needs as they arise. It was also identified that there is a continued need for illness prevention strategies and prevention of overuse injuries at future YOG. Effective strategies including hygiene education (hand washing, wearing masks, avoiding crowds, etc.), lifestyle management (travel, nutrition, sleep, etc.), and physical training and psychological load management when preparing for future YOG and other major sporting competitions should be considered and implemented [30]. Lastly, sport governing bodies at the national and international level should utilize surveillance data to better understand the relative risks of sports participation to develop effective strategies for overall optimization of youth athlete health, wellness, and performance.
Conclusions
This study reported injury and illness incidence rates for Team USA youth athletes participating at the 2024 Winter YOG in Gangwon, South Korea. Our data highlights the need to focus on female athletes and athletes participating in high-risk sports, along with considering implementation of basic respiratory illness mitigation and load management strategies at and leading up to future international competitions. It is crucial to continue focusing on the unique needs of developing youth athletes to support their safety and well-being by mitigating illness transmission and monitoring training load when preparing for sport and competing at the elite level. Therefore, continuous health surveillance between games periods in addition to continuing to collect injury and illness surveillance data at future YOG and other large-scale youth athletic events at both the national and global level is imperative.
Electronic supplementary material
Acknowledgements
The authors thank the Team USA medical staff for their efforts in documenting athlete medical encounters throughout the Gangwon 2024 Youth Olympic Games.
Abbreviations
- AD
Athlete Days
- IIS
Injury and Illness Surveillance
- IOC
International Olympic Committee
- IR
Incidence Ratio
- NOC
National Olympic Committee
- USOPC
United States Olympic & Paralympic Committee
- YOG
Youth Olympic Games
Author contributions
All authors contributed to the study conception and design, data collection and interpretation. EGP, ANT, and TA analyzed the data. ANT, EGP, TA, OS, ADG, FS, LT, ATD, JTF, ELD, JSS, and WMA drafted the paper, provided revisions and contributed to the final manuscript. WMA is the guarantor.
Funding
This study was funded, in part, by a Research Centre grant from the International Olympic Committee.
Data availability
All data relevant to the study are available upon reasonable request. Request to access data will be considered by the authors within the constraints of privacy and consent.
Declarations
Ethics approval
This study was reviewed and approved by the Institutional Review Board at the University of North Carolina at Greensboro (IRG-FY22-218).
Patient consent for publication
Not applicable.
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.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
All data relevant to the study are available upon reasonable request. Request to access data will be considered by the authors within the constraints of privacy and consent.