Injuries in recurve archers: Niestroj 2018 study

Sixty-two recurve archers, surveyed by questionnaire at two competitions in 2012, reported 52 overuse complaints and 6 acute injuries across their whole shooting careers. Forty came from the German indoor national championships in Solingen, 22 from the European outdoor championships in Amsterdam, and between them they came from eight countries.

Thirty-six of the 62, 59%, had had at least one overuse complaint, but the two groups were far apart: 28 archers at the German championship (71.8%) against 8 at the European one (36.4%), with p equal to 0.007. Archers attached to a structured squad, national or regional, had also had fewer (p equal to 0.006). More than half the complaints were in the shoulder (52.9%), and in nearly two cases out of three in the drawing shoulder (64.7%); next came the arm (23.5%), mostly the bow arm (66.7%), with the elbow the usual site. Back, hand and neck accounted for 5.9% each and fingers for 3.9%. In the European group the complaints were confined to the shoulder (88.9%) and the arm (11.1%). A good two thirds involved tendons, ligaments and joints (67.9%), and almost none were serious: 62% at grade one on the UIAA scale, the grade that needs no treatment, and 30% at grade two.

Acute injuries are another matter. Five archers reported them, all from the German championship, one of them twice. Four of the six (66.7%) were in the arm, one in the hand and one in the head, and in 83.3% of cases the cause was a component breaking during the shot: bow, arrow or string. Every arm injury was a bruise, the hand injury a cut from a broken arrow, and none went beyond grade one.

The two groups trained differently: 2.8 sessions a week of 108.1 arrows at the German championship, 5.1 sessions of 160.3 arrows at the European one, which is 274 arrows a week against 697; self-reported draw weights were 38.5 lb (17.4 kg) against 42.9 lb (19.5 kg), p equal to 0.003, and years of practice 11.8 against 15.7 (p equal to 0.061). The authors calculate an overall rate of 0.00536 injuries per thousand hours of practice (0.0048 overuse and 0.00056 acute), with 0.0084 in the German group and 0.0012 in the European one, and compare it with indoor climbing (0.027 to 0.079) and surfing (0.41).

The study is retrospective and rests on a questionnaire, 18 pages in the German version and 28 in the one used at the European championship, translated into English and French by native speakers. Archers filled it in during breaks in competition: one day at Solingen, a week at Amsterdam. Only recurve archers were admitted.

The questions collected personal details, draw weight, training intensity (arrows per session and sessions per week), competitive experience, and every acute or overuse injury of the whole career, with its site, type and consequences and, for acute ones, the circumstances. An overuse complaint is defined as damage appearing without an external cause, an acute injury as damage from a sudden event. To be counted it had to have had at least one consequence: medical treatment, physiotherapy, admission to hospital or time off work. Severity was graded on the UIAA scale, which runs from 0 (no injury) to 6 (immediate death). The two groups were compared with non-parametric tests, chi-square and Fisher, with p below 0.05 as the threshold and the band between 0.05 and 0.1 read as a tendency. The study was approved by the ethics committee of RWTH Aachen (EK 031/12).

Hours of practice were not measured but reconstructed: from each archer's training frequency, arrows per session and years of practice, using the competition pace of four minutes for six arrows. That calculation yields a total of 10,818,080 shooting hours for the 62 participants, and it is by dividing by that figure that the 58 injuries become a rate per thousand hours.

The authors list the weaknesses of the design: a whole career recalled from memory, no conversation with the athletes to check their answers, no orthopaedic examination or imaging to confirm the diagnoses the archers reported, and an age difference between the two groups (the German participants were significantly older) with no matched group of non-athletes of the same age to compare against.

A larger problem remains, which the text does not address. Sixty-two archers with around thirteen years of practice each cannot accumulate 10,818,080 hours: that would be almost 175,000 hours apiece, more than twenty years of shooting round the clock. Using the training figures given in the paper itself, around 420 arrows a week and forty arrows an hour, the total comes to a few hundred thousand hours, and the rate would be in the order of a tenth of an injury per thousand hours rather than five thousandths. The comparison with climbing and surfing rests on that denominator, so it does not hold as it stands.

There is also a question of who was measured: the participants are archers competing at a championship, which is to say the ones who did not stop. The authors acknowledge this and call it a healthy worker effect. And the rate combines two different time windows, since it counts a whole career of injuries against hours estimated from current training volume.

The idea that technique is protective, which is the paper's conclusion, is not a measured result: nobody's technique was assessed, and the European group, shooting twice as many arrows at four pounds more, reported fewer complaints, which cuts against volume and draw weight as the main causes. Finally, the figures cover recurve archery only.

For anyone who shoots, the concrete part is the map. Of the overuse complaints reported, a little over half were in the shoulder, and two out of three of those in the drawing shoulder; next came the arm, mostly the bow arm, with the elbow the typical site. Hand, fingers, neck and back were rare. Almost none were serious, and almost every archer said they had recovered completely.

Acute injuries belong to a world of their own: five people out of 62, and nearly always a component giving way during the shot, with the string then catching the forearm. The only advice that follows directly from this concerns equipment checked before and after shooting, and the armguard, which competitive archers all wear anyway.

The rest of what the paper recommends (careful technique, strength including the trunk, a draw weight matched to the archer's build) is the authors' reading of their figures, not something the study tested. That is worth knowing before repeating it.

One figure does unsettle a common belief, though: in this sample the group that shot more arrows with heavier bows reported fewer complaints, not more. Volume and draw weight on their own did not separate the archers who had been hurt from the ones who had not. And on overall risk, whatever the exact rate, the order of magnitude holds: across whole careers of daily training, 62 good-level archers accumulated six acute injuries, all of them minor.