Counting injuries: questionnaires, registers and definitions

Three choices before counting

Anyone counting archers' injuries has to decide what qualifies as an injury, over what window of time and against what denominator, and almost every disagreement between the figures starts here. The studies in chronological order are in the research line on injuries.

The definition changes from one study to the next. The German study of 2018 on 62 recurve archers counted an overuse or acute injury only if it had led to a consequence: medical treatment, physiotherapy, a hospital stay or sick leave. The Korean study of 2021, modelled on the Oslo Sports Trauma Research Center questionnaire, counted pain in a specific area that occurred during exercise or for which the archer was being treated. The Indian survey of 2017 classed as in pain anyone who answered yes to a direct question, and the survey of young archers at the European championships gave no definition of pain, as the authors themselves point out. The lowest threshold also counts a niggle that the highest leaves out.

Then there is the window: in the same Indian sample, shoulder pain affected 54.4% of archers on the day of the examination and 82.69% counting everyone who had ever had it. Other studies ask about a career, a lifetime, the last few months or fifteen days of competition. Finally, the denominator decides what kind of figure comes out. Prevalence is the share of people who have the problem at one moment or over a period; incidence counts new cases in relation to the time exposed, for example per thousand hours of shooting. Almost everything known about archers is prevalence.

The recall questionnaire

This is the most common instrument. The first sample outside kyudo, 239 archers in Florida, comes from a conference abstract with no definition of injury and no time period, so its 43.5% is the share of people who had been hurt at some point, not a rate. The German questionnaire ran to 18 pages at the national championships and 28 at the European championships, and was filled in during breaks in the competition; the young archers' survey had physiotherapists on hand, which cuts down misunderstood answers but does not check what the archer remembers.

The usual limitations are three. The first is memory, which over a whole career loses the mild complaints above all. The second is who answers: at a championship the people interviewed are those still competing, and the German authors liken this selection to the healthy worker effect of occupational medicine. The third is an instrument built for something else: in 13 young Turkish archers, surveyed with a questionnaire designed for office work, the complaints mentioned most often were in the back, the only survey of complaints in which the shoulder does not come first.

Examinations and imaging

In 1971 a group of Japanese orthopaedic surgeons collected questionnaires from 122 kyudo practitioners and examined and X-rayed the thirty with the most marked complaints. Only one practitioner in four had seen a specialist, so anyone who counts injuries from medical care sees fewer than there are.

An examination adds precision, not certainty. In the Indian survey the Hawkins-Kennedy test for shoulder impingement was positive in 80% of archers with pain and in 38.02% of those without: it points to possible strain, not to a diagnosis. In the 58 Korean archers ultrasound found tendinosis of the long head of the biceps in 22.4% and subacromial bursitis in 10.3%, findings that describe the tissues and do not on their own explain the pain reported.

The denominator of hours

The most quoted figure, 0.00536 injuries per thousand hours of shooting, comes from the German study, the only one in the registry that relates injuries to hours. Those hours were reconstructed from sessions, arrows per session and years of practice, using the competition pace of four minutes for every six arrows. The total, 10,818,080 hours for 62 archers, comes to almost 175,000 hours each, some twenty years of shooting without ever stopping, and the rate places a whole career of injuries over hours estimated from the declared training volume.

In 2021 a review of thirty-three Olympic sports took up that figure and placed archery last among the twelve disciplines with a rate per thousand hours, relying for archery on that single study. The same review warns that the ranking changes with the metric: the three measures in use cover twelve, thirteen and four disciplines, and archery is lowest only in the one per thousand hours. The claim that archery carries a low risk of injury is contested: measured severity is low, the frequency of complaints is high.

Hospital records

The large numbers come from emergency departments. Ten years of US data, from a system that collects visits to around a hundred hospitals, give some 43,000 archery-related injuries: in men the finger accounts for 66.2% of sites and the shoulder for 5.4%, with cuts the most common injury. The product code, however, covers equipment, clothing and activity, and the database records incidents at home, on farms or at school without saying whether anyone was shooting in competition. Acute events reach the emergency department, and anyone hurt who does not seek emergency care is missing, as the authors themselves note; severity, moreover, is not recorded. The ratio of 4.4 between men and women is a ratio of cases, and the article itself notes that most people who shoot are men.

The same applies to smaller archives, such as the two paediatric eye injuries in Indianapolis or the six arrow wounds from Bhutan: they count cases without knowing how many people were shooting. The claim that acute injuries mainly affect the fingers and hand is contested because the two windows do not see the same people: among the German and European competitive archers there were six acute injuries in whole careers, four of them bruising to the arm.

Surveillance at a competition

The only count in the registry made going forward, day by day, comes from the Tokyo 2020 Paralympic Games: 139 para-archers followed for fifteen days, with 10 illnesses, 4.8 per thousand athlete-days, and 7.2% of the archers affected; in para-shooting the rate was 6.1, with confidence intervals that overlap almost entirely. It counts illnesses rather than injuries, however, arrives second-hand through a 2024 review that swaps the two rates in one table, and concerns Games held during the pandemic. The claim on illness among para-archers at competitions remains not studied until the original study enters the registry.

What this changes in the claims

That more training days bring more overuse injuries is contested, and that archers at a higher level and in a squad get injured less is only reported: with a recall questionnaire there is no telling whether those who were hurt cut down their sessions, or whether those who tolerate heavy loads reached the top precisely because they get injured less. On recurve against compound the two studies measure different things, all injuries in Florida and shoulder pain in India. The shoulder as the most frequent site is corroborated, by contrast, because six samples collected with different instruments point the same way, while common but mild shoulder pain and pain lasting months in elite young archers remain reported.

No study in the registry has followed a group of archers through a season counting new injuries against the arrows actually shot, and a 2026 systematic review of fifteen exercise studies in archers found that almost none report incidence, severity or days lost.

What to check

• the definition: reported pain, damage with consequences, an emergency department visit;
• the window: the day of the examination, the last few months, the career, the lifetime;
• the denominator: people, measured hours, reconstructed hours, athlete-days, or none at all;
• who collects the data: the archer alone, a physiotherapist present, an examination, a medical record;
• who is missing: those who stopped are not competing, those who do not go to hospital are not in the archive;
• whether the questionnaire was designed for sport or for another purpose.

How design and sample are weighed is explained in How we read a study; guidance for archers is in the article on injuries in archery, and what is known about under-eighteens is on the page on young archers.

@misc{campagna2026_enresearchmethodscountinginjuries,
  author = {Campagna, Matteo},
  title = {Counting injuries: questionnaires, registers and definitions},
  year = {2026},
  howpublished = {Research, matteocampagna.com},
  url = {https://matteocampagna.com/en/research/methods/counting-injuries},
  note = {accessed 2026-10-16}
}