Injuries in young archers: Vasilis 2024 study

Two hundred adolescent archers from 34 countries, interviewed during the European Youth Championship in Patras, answered a questionnaire on training, pain and injury. There were 104 boys and 96 girls, 16.9 years old on average and with 6.5 years of practice behind them; 145 shot recurve and 55 compound. The training load they reported is high: on average almost 15 hours a week, about five sessions, a little over 160 arrows per session and around ten competitions a year.

Half the group, 101 of the 200, reported training-related pain lasting more than three months, with a mean duration of 3.9 months and a mean intensity of 5.94. One hundred and sixty-five athletes reported pain in at least one area of the body, 46 in two areas and 5 in three. The shoulder is the commonest site, at 49.1% of participants, followed by the spine, where the lower back weighs more heavily than the thoracic and cervical regions. Lateral epicondylitis, so-called archer's elbow, affected 8%, the fingers 7% and the thoracic spine 4.6%; there were no cases at the hip.

The questionnaire also measured signs of central sensitisation with the Central Sensitization Inventory. Sixteen athletes out of 200, that is 8%, passed the cut-off of 40 points out of 100: eleven in the moderate band, three in the severe band and two in the extreme band. The questionnaire score showed no association with weekly training frequency, session duration, number of competitions a year or match duration.

On how the pain was handled, 31% of those interviewed said they used medication in order to train, and of these half reported negative effects and a third mild effects; some reported taking drugs for depression and for neuropathic pain. Physiotherapy had been used by 52.3%, and 31.8% had had to stop training because of an injury. Only 32% said they felt no pain or discomfort at all during the shot routine, while 45% reported difficulty executing their technique because of pain. Eighty-three per cent said they told their coach about it.

From the training data the authors draw a second picture: 84.5% of the group did strength work for the upper body and 72.5% for the drawing arm, while only 49% did strength work for the lower body and 49.5% any aerobic conditioning. Stretching was done before training by 73% and afterwards by 58%, warm-up by 88% and cool-down by 44%; 54.5% had an annual physical assessment and 33% followed a prescribed diet.

The study is cross-sectional and rests on a structured questionnaire, administered in person at the Panpeloponnisiako stadium in Patras during the European Youth Championship. Boys and girls aged 13 to 20 taking part in the event who could follow instructions in Greek or English were eligible. The questionnaires were filled in daily, at the end of training and before matches, in an area set up inside the stadium, and took about fifteen minutes; a team of a physiatrist, two physiotherapists and two physiotherapy students was on hand to explain the questions, and four physiotherapists conducted the interviews.

The questionnaire has four sections: the athlete's personal data; training and bow characteristics, covering handedness, years of practice, hours of practice and competition per week, nutritional habits and pre-season testing; training-related pain, with its site, mechanism, type and treatment; and general health, with any concurrent problems and previous treatment. The full questionnaire is attached to the paper.

Central sensitisation was assessed with part A of the Central Sensitization Inventory, twenty-five items answered from 0 ("never") to 4 ("always") for a total of 0 to 100, using a cut-off of 40 points and both the English and the Greek version of the instrument. The analysis is descriptive, with means, standard deviations and proportions; a chi-squared test compares proportions between boys and girls, an independent-samples t-test the continuous variables, and a Pearson correlation relates the questionnaire score to weekly frequency, session duration, number of competitions a year and match duration. Significance was set at p < 0.05. The study was approved by the ethics committee of the physiotherapy department of the University of Thessaly on 2 October 2018 and authorised by World Archery, with written consent from the athletes and from the national team representatives.

Everything the study reports is self-reported, with no examination: the authors acknowledge the risk of inaccurate recall and write that the word "pain" was not defined, so some participants may have reported muscle soreness from a heavy session rather than an overuse problem. They add that some may have hesitated to declare a symptom for fear of how it would affect their coach's decisions, and that filling in the questionnaire on the day of competition may have influenced the answers. A clinical examination for each reported symptom would give a firmer picture, but it is not practicable during an event.

The design is cross-sectional and captures one moment only: it does not say how many new injuries appear over a season, follows nobody over time and cannot link a training load to an outcome. The sample, moreover, consists of those who were competing and fit to compete, so anyone who had stopped because of a serious problem does not appear. The setting is a European youth championship: the figures describe selected archers with many hours of training, not those who shoot at a club.

Several figures do not agree with one another. The paper's abstract gives 43.5% for shoulder pain, the results section 49.1% and the discussion "over half" of the participants. In the descriptive table the draw weight row reads 15.44 lb for the girls and 16.99 lb for the boys, values identical to the boys' age and the girls' training hours and far too low for archers at this level: the row looks copied from the others and cannot be used. The correlation table pairs coefficients and p values that are incompatible with each other, for instance r = 0.69 with p = 0.335 on two hundred athletes, so the absence of an association between sensitisation score and training load should be taken cautiously. The discussion reports a mean match duration of 129 minutes, the table 103. The mean pain intensity, 5.94, is reported without saying on what scale.

Finally the date. Ethics approval is from October 2018 and the acknowledgements name the technical delegate of the 2018 European Youth Championship, while the paper appeared in 2024: the data therefore describe a generation of athletes six years before publication. The passages in the discussion on alignment, on strengthening the trunk and the lower limbs and on their effect on injury are not findings of this study, which measured neither technique nor strength.

What stands out is how common it is. At a European youth championship, half of the two hundred archers present were living with training-related pain that had lasted more than three months, and only a third said they shot without any discomfort at all. The shoulder is by far the commonest site, about one athlete in two, and the second is the lower back. Anyone coaching young people who shoot fifteen hours a week and a hundred and sixty arrows a session has here an order of magnitude for how widespread the problem is at that load, even though the study does not show that the load is what causes it.

Two figures concern what surrounds the pain rather than the pain itself. Thirty-one per cent used medication in order to train, and half of those reported that it did them no good; a few were taking drugs for depression or for neuropathic pain. Sixteen athletes out of two hundred passed the cut-off on the central sensitisation questionnaire, meaning they reported a pattern of symptoms that goes beyond the painful area. Pain that has lasted for months is a matter for a doctor or a physiotherapist, and no record of a study replaces that assessment.

On training the picture is descriptive: in this group 84.5% did strength work for the upper body and 72.5% for the drawing arm, while fewer than half worked on the lower limbs. The authors read that imbalance as one of the reasons for the lower back pain, but it is their interpretation resting on other literature, not a result measured here: in this study the training load was never related to the site of the pain. It is still worth knowing that 8% reported archer's elbow and 7% a problem with the fingers, lower proportions than other work reports, which the authors put down to the protection given by these athletes' equipment.