Risk Prediction of Injury Among Recreational Badminton Players in India

Abstract

Background/Purpose

Since badminton has emerged as a frequently played non-contact recreational sport in India, it is essential to document the injury patterns and incidence. However, there is no existing literature on this topic among Indian players.

Materials and Methods

A web-based questionnaire was circulated among recreational badminton players across North India, enquiring about demographic details, injury characteristics, and factors associated with an injury like BMI, warm-up practice, and physical training.

Results

Data of 237 eligible participants revealed an injury incidence rate of 57.1%. The ankle and dominant-side shoulder were the most common anatomical regions affected. The most common injury types were ligament sprain and muscle/tendon strain. Factors like age, frequency, duration of play, type of footwear, BMI, prior warm-up, court surface, and physical training were significantly associated with injury incidence on univariate logistic regression analysis. On multivariate logistic regression analysis, we found male gender, a lack of prior warm-up, inadequate physical training, and age group between 26 and 30 years to be four independent risk factors for injury.

Conclusion

The recreational badminton player of India had a relatively higher incidence of injury compared with the limited published data from other countries. Modifiable factors like a proper warm-up before the game, regular physical fitness training, and injury awareness programs can reduce the injury rates.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43465-022-00663-y.

Introduction

Badminton is one of the fastest, active non-contact racquet sports, which has attracted many people in recent years due to its visually elegant game style and the high amount of energy burnout per time. Nowadays, badminton is also played for maintaining an optimal fitness level in daily routine [1, 2].

Badminton is gaining popularity in India because of the minimum requirements of only two players and limited ground area requirements compared to other popular sports like cricket and football. The physical exertions required in badminton involve a summation of repetitive movements, agility, and stamina that can place significant loads on the whole body and make players susceptible to injury [3]. Lack of awareness relating to proper playing techniques and warm-up activities makes recreational players more prone to injuries. It has been estimated that badminton injuries account for 1–5% of all sports injuries [4–6]. Additionally, recreational players continue to play badminton despite minor injuries by ignoring them, leading to worsening and even complications.

The literature shows a lack of epidemiological data and common injury patterns among recreational badminton players in India [7, 8]. Thus, this study was undertaken in a non-professional sub-group of players to evaluate the injury patterns and factors associated with injuries.

Methodology

A web-based survey was done using a questionnaire developed on Google form (Google LLC, California). This observational study was carried out after the Institutional Ethics committee (Reference no. NK/7356/B.Ph.T/112) approval. A series of questions were formulated, evaluated, and verified by all the investigators. The questionnaire [attached as a supplementary file] comprised questions regarding the demographic profile of the participant, the duration of play in a week, amount of time spent on badminton game, warm-up practice like static stretching, dynamic stretching, aerobic exercises, and warm water bath along with cool-down information practiced, history of badminton-related injuries, body part affected, type and number of injuries, also the level of play affected by these injuries, court surface (indoor floor surfaces like wooden, rubber, concrete and outdoor floor surfaces like grass, etc.), choice of footwear, and the practice of physical fitness training like aerobic training, weight training, pilates training, and circuit training. An injury was defined as any pain and/or discomfort reported by players to the medical staff and receiving medical attention. This injury definition was based on the criteria adopted in the previous research on badminton injuries [7, 9]. Various trial runs for understanding the perception of questions by the public were done to inspect the quality of the questionnaire and decrease the uncertainty of the options included. This was achieved by circulating it among our institute's 20 known recreational badminton players. Before initiating the collection of actual study data, the data of these 20 participants were erased.

Participants filling out the questionnaire were informed about the study’s aim and objectives. A proper informed consent was obtained, and the participant's information was kept confidential and responses anonymous. The inclusion criteria of participation in the study were age > 15 years of either sex and participant playing badminton for recreational purposes only for at least 1 year. The exclusion criteria included professional/elite players, para (wheelchair) badminton players, participants younger than 15 years old and older than 60 years old, and participants with any neurological disorder. A questionnaire link was circulated via various social media platforms (WhatsApp, Instagram, Facebook Corp., CA, USA, and E-mails) across North India. The contacts of the badminton players were collected through known players across various badminton courts, coaches, and students who are playing for recreational purposes. The period for data collection was 14 days, with two reminders being delivered to complete the questionnaire. The data collection was stopped 7 days after the third reminder. The data were exported in a Microsoft Excel format and was scanned for incomplete and duplicate responses. SPSS software version 22.0 was used to analyze the data.

Statistical Analysis

The Shapiro–Wilk test was applied to check the normal distribution of continuous data. Mean and standard deviation (SD) were calculated for normally distributed continuous data; otherwise, median and interquartile range (IQR) was calculated. Categorical variables were presented as frequency and percentages. An independent t test was used to compare normally distributed quantitative variables between two groups. For skewed data, the Mann–Whitney U test was applied. Chi-square test or Fisher’s exact test (whichever applicable) was used to study the association between categorical variables and study subgroups. Logistic regression was applied to find out independent predictors. A two-tailed p value ≤ 0.05 was taken as statistically significant with a 95% confidence interval.

Results

Out of 458 recreational badminton players contacted, 251 responded through the web-based questionnaire. After segregation and resolution of duplicates and incomplete data, 237 participants’ data were taken up for final statistical analysis.

Among 237 participants, there were 149 (62.9%) female and 88 (37.1%) male players. The mean age of the participants was 23.5 years (SD: 5.95). The number of right-handed badminton players was 225, and left-handed was 12. Demographic and characteristics details of these participants are given in Table 1. The injury incidence rate among the participants was 57.8% (137 participants). There were 70 male (51.1%) and 67 female (48.9%) injured players.

Table 1.

Demographics and characteristics of recreational badminton players

S. no.	Demographic details	Categories	Number (%)
1	Gender	Female	149 (62.9%)
		Male	88 (37.1%)
2	BMI	Less than 18.5	21 (8.9%)
		18.5–24.9	163 (68.8%)
		25.0 and above	53 (22.3%)
3	Hand dominance	Right-handed	225 (94.9%)
		Left-handed	12 (5.1%)
4	Category of play	Single Doubles	187 (78.9%) 92 (38.8%)
		Mixed doubles	47 (19.8%)
5	Experience of play	1–2 years	43 (18.2%)
		2–5 years	91 (38.4%)
		More than 5 years	103 (43.5%)
6	Occupation	Student	188 (79.3%)
		Employed	49 (20.7%)

Characteristics of Injury and Management

A total of 251 badminton-related injuries were recorded among 237 players (Fig. 1), ranging from musculoskeletal issues like sprain, strain, fracture, overuse injury, and other injuries like blunt trauma to the eye. The most common anatomical area that sustained an injury by the players was the ankle (27.8%) and the dominant-side shoulder (18.7%) (Fig. 2). Out of the injured population (n = 137), 83 (60.6%) followed a proper rehabilitation protocol for injury management. Ninety (65.7%) players answered that they returned to the same level of play following an injury. None reported permanent discontinuation of play due to injury. A total of 165 (69.5%) players were already aware of various badminton-related injuries.

Fig. 1.

Bar chart showing different body regions sustained injuries among recreational badminton players

Fig. 2.

Bar chart showing different type of injuries sustained by recreational badminton players

Factors Affecting the Incidence of Injury

Univariate and multivariate logistic regression was performed to identify the factors affecting the injury rate (Table 2).

Table 2.

Univariate and multivariate logistic regression analyses to determine risk factors for recreational badminton players to get injured

Factor affecting population	Injured population (n = 137)	Non-injured population (n = 100)	Unadjusted Odds ratio (univariate analysis) (95% CI)	P value	Adjusted Odds ratio (multivariate analysis) (95% CI)	P value
Age (in years)
16–20	36/137 (26.3%)	37/100 (37%)	Reference	0.002	Reference	0.12
21–25	63/137 (46%)	58/100 (58%)	1.11 (0.62–1.99)	0.710	1.43 (0.74–2.77)	0.27
26–30	16/137 (11.7%)	1/100 (1%)	16.44 (2.07–130.54)	0.008	11.84 (1.36–102.4)	0.02
> 30	22/137 (16.1%)	4/100 (4%)	5.65 (1.77–18.03)	0.003	1.70 (0.42–6.89)	0.45
Gender
Male (n = 88)	70/137 (51.1%)	18/100 (18%)	4.76 (2.58–8.76)	0.001	2.23 (1.02–4.88)	0.04
Female (n = 149)	67/137 (48.9%)	82/100 (82%)	Reference	–	Reference	–
BMI ratio
Less than equal to 18.5	9/137 (6.6%)	12/100 (12%)	0.65(0.26–1.62)	0.353	0.65 (0.23–1.85)	0.42
18.5–24.9 (normal)	88/137 (64.2%)	76/100 (76%)	Reference	0.006	Reference	0.20
25.0 and above	40/137 (29.2%)	12/100 (12%)	2.88 (1.41–5.88)	0.004	1.86 (0.80–4.29)	0.14
Years of playing experience
Less than equal 2 years	26/137 (19%)	17/100 (17%)	Reference	0.48	–	–
2–5 years	56/137(40.9%)	35/100(35%)	1.04 (0.49–2.19)	0.90	–	–
More than 5 years	55/137(40.1%)	48/100(48%)	0.74 (0.36–1.54)	0.43	–	–
No. of days playing in a week
Less than equal to 3 days	72/137(52.6%)	71/100(71%)	Reference	–	Reference	–
More than 3 days	65/137(47.4%)	29/100(29%)	2.21 (1.27–3.8)	0.004	1.46 (0.75–2.88)	0.11
Average duration of play in a day
Less than equal to 1 h	85/137(62%)	79/100(79%)	Reference	–	Reference	–
More than 1 h	52/137(38%)	21/100(21%)	2.30 (1.27–4.16)	0.006	1.39 (0.67–2.86)	0.37
Warm-up (yes) n = 138	67/138(48.5%)	71/138 (51.5%)	0.39 (0.22–0.67)	0.001	0.51 (0.27–0.97)	0.04
Cooldown (yes) n = 154	94/154(61.1%)	60/154(38.9%)	1.45 (0.85–2.49)	0.170	–	–
Footwear
Non-marking shoes	48/137(35%)	22/100(22%)	Reference	–	Reference	–
Sports shoes	89/137(65%)	78/100(78%)	0.52 (0.29–0.94)	0.031	1.09 (0.49–2.40)	0.82
Court surface
Wooden court	37/137(27.0%)	16/100(16%)	3.2 (1.55–6.82)	0.002	1,66 (0.66–4.20)	0.27
Concrete court	54/137(39.4%)	29/100(29%)	2.61 (1.38–4.96)	0.003	1.42 (0.66–3.03)	0.36
Rubber/synthetic court	14/137(10.3%)	10/100(10%)	1.96 (0.77–4.98)	0.15	1.01 (0.33–3.4)	0.98
Outdoor/soft grass court	32/137(23.4%)	45/100(45%)	Reference	–	Reference	–
Physical fitness training (yes) n = 139	65/139 (46.7%)	74/139 (53.3%)	0.31 (0.18–0.55)	0.001	0.31 (0.16–0.59)	0.01
Aware of badminton injuries (yes) n = 165	98/165 (59.3%)	67/165 (40.6%)	1.23 (0.70–2.16)	0.454	–	–

Univariate Logistic Regression Analysis

This analysis found player-related factors like age, gender, BMI, physical fitness training, warm-up before the game, number of days played in a week, duration of play, court surface, and footwear were significantly correlated for injury incidence (p value < 0.05) (Table 2).

On sub-group analysis, the players with age more than 26 years old were more prone to injury than age group less than 25 years (p value < 0.05). In the case of gender, the male players were found to have 4.76 times increased risk of injury than the female one [odds ratio (OR) 4.76; 95% CI 2.58–8.76; p value = 0.001]. Players with Body Mass Index (BMI) 25 and above were 2.8 times more prone to injury as compared with players having BMI of 18.5–24.9 (OR 2.88; 95% CI 1.41–5.88; p value = 0.004). Those who undergone physical fitness training were 0.31 times less prone to injury incidence as compared to non-trainers (OR 0.31; 95% CI 0.18–0.55; p value = 0.001). Warm-up practicing before the start of play decreased the injury incidence by 0.39 times (OR 0.39; 95% CI 0.22–0.67; p-value = 0.001). In the case of the number of days played in a week, participants who played more than 3 days a week had 2.21 times more risk of injury than those who played less than 3 days a week [odds ratio [(OR): 2.21; 95% CI 1.27–3.81; p value  = 0.004]. For the duration of play in a day, more than 1-h play per day group participants were 2.30 times more prone to injury than those who played less than or equal to 1 h (OR 2.30; 95% CI 1.27–3.81; p value  = 0.006). Those players who played over wooden and concrete courts sustained a significantly higher number of injuries as compared to those played in outdoor/soft grass court (p value < 0.05). In the aspect of footwear, sports shoe users were 0.52 times less prone to injury as compared to non-marking shoe wearers (OR 0.52; 95% CI 0.29–0.93; p value = 0.031).

Multivariate Logistic Regression Analysis

Independent risk factors for injury were determined by performing multivariate logistic regression analysis of factors that were significant in univariate analysis. This analysis showed both modifiable and non-modifiable risk factors. Modifiable risk factors were warm-up practice and physical fitness training, which significantly decreases injury rate by 0.51 times (OR 0.51; 95% CI 0.27–0.97; p value = 0.04) and 0.31 times (OR 0.31; 95% CI 0.16–0.59; p value = 0.01), respectively. Non-modifiable risk factors determined were age group between 26 and 30 years and male gender, which significantly increased injury rate by 11.84 times (OR 11.84; 95% CI 1.36–102.4; p value = 0.02) and 2.23 times (OR 2.23; 95% CI 1.02–4.88; p value = 0.04), respectively.

Discussion

The epidemiology of badminton injuries has been documented to be diverse in different populations. The available literature suggests that injury incidence varies globally and differs even in the same population when comparing elite and recreational players, male and female sex, and players of different age groups [10]. Exploring the epidemiology of injuries in a given population is important to identify the extent of injury and ways to implement injury prevention programs. There is a relative scarcity of epidemiological literature focusing mainly on recreational badminton players when comparing elite players [7, 9, 11–13]. To the best of our knowledge, the present observational study is the first one from India in badminton, highlighting the injury incidence, characteristics, and risk factors for injury among recreational badminton players.

The injury rate of the population evaluated was 57.8%, which is comparatively high. A study by Muttalib et al. in 2009 on Malaysian recreational players reported a 39.2% injury rate [12]. A recent review by Pardiwala et al. [8] on elite badminton players documented that the injury incidence varied between 0.9 and 7.38 per 1000 h of play. Marchena-Rodriguez et al. [7] from Spain, in their cross-sectional study among amateur badminton players, documented the mean rate of injury being 0.134 per 1000 h of play. Various studies used different definitions for injury incidences in the literature, such as the number of injuries per year per person, number of injuries per thousand players per year, and number of injuries per thousand hours (where 1 h equals 1 h of sports participation) [9, 13, 14]. Therefore, the exact comparison of injury incidence with the players of different countries is not feasible as the unit of measurement varies.

In our survey, the lower limb was the most commonly affected. Furthermore, in the lower limbs, the ankle, followed by the knee, was the most affected body part. In the case of the upper limb, the dominant-side shoulder was the common body region prone to badminton-related injury. The most affected part in the lower limb varied in different studies. Some studies reported the knee as the most commonly injured part [9, 15, 16], while others reported the ankle as the most commonly affected part [10, 17]. Pardiwala et al. [8], in their review on elite badminton players, reported knee followed by the ankle is the most commonly affected anatomical region, and the same finding was documented by Marchena-Rodriguez et al. [7]. Muttalib et al. [12] documented that the shoulder is a commonly affected region among Malaysian recreational badminton players.

Also, our study reported a few cases of sports-related eye/ocular trauma. Although the incidence is less, it is becoming quite prevalent due to advancements in the playing techniques and/or during powerful smashes, even among amateurs. It may also be due to a collision with a doubles partner [18, 19]. Ligament sprain and muscle/tendon strain were the most common type of injuries in our observation. The diagnosis was made by either a medical practitioner, an orthopaedician, or a sports physiotherapist according to the definition of injury mentioned in the methodology section. However, recall bias among the participants may be inherent. Marchena-Rodriguez et al. [7] documented that muscle injury was more common than ligament injury/sprain. Our findings showed injury incidence rates were more among comparatively older players (age > 25 years) while comparing younger players (< 25 years). Pardiwala et al. [8] documented that overuse injuries were common among elite players when all age group players were considered. In contrast, acute traumatic injuries were three times more common than overuse injuries among junior elite players [14]. Based on gender in a study on elite players, the comparison reported female injury prevalence higher than males [20]. However, in our study, the male population was more prone to injury than females, possibly due to more involved play effort, level of aggression, and style.

Our findings suggest that players with BMI ≥ 25, the risk of getting injured was higher. The literature documented that lower limb (ankle and knee) was more susceptible to getting injured with high BMI players. The possible reason is that high BMI players' rapid change in direction and momentum during the game challenges the ankle and knee stability and makes them prone to injuries. Richmond et al. [21] in their study on the Canadian adolescent population, found that there was a 34% increased risk for all sports injury in obese adolescents compared to healthy adolescents [22].

The increased duration and frequency of play make the recreational players more prone to injury. The warm-up practice and physical fitness training showed a reduced risk of injury, which makes both factors reduce the injury incidence rates. In India, there is a lack of injury surveillance in elite and recreational badminton players; this limits our ability to accurately determine the injury burden on this cohort. This study provides a genesis for further research in badminton sport and recreational players. Awareness and implementation of proper warm-up and physical training protocol should be considered to minimize injury rates. A proper warm-up period calculation should be considered in future research as warm-up practices were quite variable for recreational players. Due to recent advancements and playing techniques, frequent and more epidemiological studies should be considered in this sport. The future study protocols should also assess various clinical findings like joint laxity, muscle strength, joint range of motion, etc., to determine injury patterns and factors associated with it.

Limitations of Our Study

Being a retrospective questionnaire-based survey, recall bias is inherent. Also, we did not document the severity and management of injuries (how many underwent surgical interventions?) that occurred to the participated players. Due to the retrospective nature of this study, the total exposure time to the match/training was not calculated. Although none of them quit the game following injury (return to sports), the average time loss of play per injury was not calculated.

Conclusion

The incidence of injury among Indian recreational badminton players is relatively high, and it is more prevalent in the ankle and dominant-side shoulder region. Modifiable factors like a proper warm-up before the game, regular physical fitness training, and injury awareness programs can reduce the injury rates among recreational players. It is the need of the hour to do proper documentation of the injuries, and to create awareness and implement the injury prevention strategy among Indian amateur badminton players.

Supplementary Information

Below is the link to the electronic supplementary material.

Authors contributions

KR: conceptualization, manuscript drafting, and critical revision of the manuscript. SS: manuscript drafting and data collection. NRG: manuscript revision, data curation, and supervision. AK: statistical analysis and data curation. SN: data collection. MSD: supervision and critical revision of manuscript.

Funding

Nil. None of the authors received financial support for this study.

Declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statement

Institute Ethics committee approval was obtained before conducting the study (Reference no. NK/7356/B.Ph.T/112).