4.1. Injury Incidence
Previous epidemiology studies (Table 3
) on badminton have ranged from 1 to 8 years in duration, with an average of three years [7
]. Injuries to the lower extremity represented between 50% and 92% of all injuries in these studies with the majority being mild to moderate in nature. Our proportion of lower limb injuries was 44% for our dataset. To our knowledge only three studies have reported incidence of injury [7
], and this has varied depending on player performance level and method of injury data collection. In players ranging from club to international level, the incidence of injury was reported [10
] as 0.09 and 0.14 injuries per person per year for males and females respectively using an injury questionnaire for data collection. These incidence rates (1% and 1.4%) were much lower than the study [7
] of elite players in Hong Kong where the incidence was 5.04 injuries per 1000 (0.5%) of elite players using data collection from medical records. Goh et al.
also used medical records as the source of data [18
] and reported an incidence rate of 0.90 calculated as the number of injuries divided by the total athlete-time at risk.
4.2. Injured players’ Characteristics
Age has been reported as a risk factors for sports injuries [20
], and for our badminton study, there were more injuries in players aged 10–19 years and 40–49 years. Other authors have also reported age as a risk factor for badminton (Table 3
). Previous studies using data across performance levels have presented three age-bands: under 16, 16–25 and above 25 [11
]; or under 18, 18–25 and above 25 years old [12
]. Although the greater number of injuries was seen in the higher age-groups, the results lack specificity due to a much wider age range of 7–57 years [12
] and 10–60 years [13
]. The lower age-bands used in previous work may have been chosen due to a lower mean age of players compared to our study.
Kimura et al.
] reported the greatest number of anterior cruciate ligament (ACL) injuries occurred in the 16–20 years age-group. This may support the evidence of the mechanisms of injuries among the 10–19 years age group in our current study. The high incidence of injuries among 40–49 years old could be due to the ageing process, which may result in reduced mobility, musculoskeletal strength and kinaesthetic awareness [21
]. The difference in mean age was greater for females when comparing the present study (38.1 ± 17.5 years) with earlier studies; 21.6 years [12
] and 26.0 years [13
]. As the risk of injury varies with age, attempts to plan training individually and to institute injury prevention measures should be made. As an example, the FIFA 11+ warm-up programme, is designed to reduce lower limb injuries, including ACL injuries, among football players aged 14 years and older (http://f-marc.com/11plus/home/
Epidemiology studies on badminton injuries.
Epidemiology studies on badminton injuries.
|Reference||Badminton players gender and age bands||% of players injured||Main injury type (%)||Causes of injuries (%)||Source of data|
|Chard et al. ||74 M; 54 F. ≤ 15; 16–25; ≥ 26.||3.1 (≤15 years); 46.9 (16–25 years); 50.0 (≥26 years)||collateral ligament injuries (28); meniscal injuries (25); cruciate ligament injuries (12.5)||NA||hospital registration|
|Fahlström et al. ||67 M; 11 F. 31.9 (range 11–52).||80.8 (<40 years)||Achilles tendon ruptures (34.6); ankle sprains/fractures (29.5); knee injuries (16.7)||NA||hospital registration|
|Goh et al. ||34 M; 24 F. 14.3 ± 1.1 (range 13–16)||56.9 (61.8 M; 50 F)||knee injuries (27), sprain/strain in lower limb (36.5); back/spine injuries (25.4); sprain/strain in trunk (25.4)||NA||medical records|
|Hensley et al. ||157 M; 74 F. 33 ± 13.1 M; 27 ± 8.2 F.||82.8 (M); 81.1 (F)||sprains or ligament injuries (43.7); blisters (37.8); muscle strains or tears (24.3); bruises (23.2)||Retrieving or positioning (36); stroking (29); collision with person (22)||badminton injury questionnaire|
|Hoy et al. ||2620 injured; 1650 M; 970 F. 28.2 (range 10–60).||2.8 (<18 years); 4.5 (18–25 years); 4.2 (>25 years)||sprains (54); Achilles tendon ruptures (13); tears (10); fractures (6)||NA||hospital registration|
|Kimura et al. ||6 M; 15 F. 21.9 ± 7.9 (range 13–38).||9.5 (<15 years); 52.4 (16–20 years); 19.0 (21–25 years); 4.8 (31–35 years); 14.3 (36–40 years)||ACL injuries (100)||single leg landing (48); plant-and-cut (38)||medical records|
|Kroner et al. ||217 injuries in 208 patients; 136 M; 72 F. 29.6 (range 7–57).||1.4 (<18 years); 2.3 (18–25 years); 2.3 (>25 years)||joint/ligament injuries (58.5); muscle injuries: strains/tears (19.8)||falling (62); struck by shuttle or racket (8)||hospital registration|
|Shariff et al. ||190 (no sex stated). 19.2 (range 13–52).||58.8 (<20 years)||patellar tendinopathy (42.7); muscle strain (11.8); meniscus or ligamentous injuries (10.9)||NA||medical records|
|Yung et al. ||20 M; 24 F. 20.1 ± 4.4 (range 13–28).||43.2 (21–28 years, elite senior); 25.0 (16–21 years, elite junior); 31.8 (13–18 years, potential)||strains (64); sprains (14.4); facet injury (14.4)||NA||medical records|
The greater proportion of some injuries in males in the current study was similar to that in previous work [11
]; nevertheless participation rate was not accounted for as gender participation numbers were not available from Badminton New Zealand. In studies where an elite sample [15
] and community participation [12
] were adjusted for, the risk of injuries to males and to females was comparable. In our study we reported a greater number of sprains to the cruciate ligament in males (75/114) than in females. In contrast, Kimura et al.
] reported a greater frequency of ACL injuries to females (15/21). Our review of articles that reported the incidence of ACL injuries by gender [24
] showed there was a greater risk of ACL injuries for females. Although biomechanical, structural and neuromuscular risk factors for ACL injury have been established [25
], they are not necessarily unique to females. These risk factors may be considered as associations and not necessarily causal [26
]. Further work is required to examine gender differences for risk of ACL injury, and causative risk factors for injury in badminton players.
In terms of ethnicity, the high percentage of Asians (37%) injured in the current study was greater than the proportion of Asians in the NZ population (12%) [27
], which could be due to a preference for badminton as a sport for Asians in New Zealand compared with other activities.
4.3. Causes of Injury
Injuries can result from the player’s own movements and may arise from a rapid change to a motor control plan [6
]. Few studies have detailed the causes of badminton injury. Hensley and Paup [10
] reported that most injuries were intrinsic rather than extrinsic, either from a retrieving/positioning (36%) or stroking (29%). Using interviews and an examination of the medical records of 21 badminton players with ACL injuries over six years, Kimura et al.
] established that the most common cause of ACL injury was a single-leg landing after an overhead shot, typically on the knee opposite to the racket-hand side. The next most common cause of ACL injury was planting and cutting during a side-step with the knee on the racket-hand side [16
]. Ten out of 21 (47.6%) players injured their ACL when landing on a single leg after an overhead shot following a backward step [16
], whereas landing and jump-landing accounted for 12.5% of ACL sprains in our study. Turning the body and side-stepping was responsible for 38% of ACL injuries in Kimura et al.
’s study [16
] compared with 34.4% as a result of turning/changing direction/shifting weight/pivot/twist in our study.
Depending on the degree of flexion, multi-planar loading during the plant-and-cut movement may increase the force through the ACL above that of sagittal motion alone [28
]. Greater force increases the strain through the ligament which could increase the potential for injury [28
]. Badminton is a fast paced game where players have little time to react to the stimulus of the shuttle, similar to unanticipated planting and cutting in other sports. There is some evidence that unanticipated movements result in greater varus/valgus and internal/external rotation moments at the knee compared to anticipated ones [31
]. Additionally, holding a racket may further increase peak external knee abduction moment due to postural alterations [32
4.4. Limitations of Injury Data Sources
Different sources of injury data can result in different conclusions being drawn around risk factors for injury. Our data source was the national insurance compensation system that provides treatment and rehabilitation for any person in New Zealand via a medical practitioner (e.g. general practitioner, hospital, physiotherapist). In both studies by Kroner et al.
] and Hoy et al.
] records were obtained from admissions to a casualty ward. Using the ACC database as a source has a greater analytical scope as it also includes patients that did not require emergency treatment at a hospital. This means lower severity injuries are recorded in the ACC database, resulting in a relatively high proportion of sprains and contusions being reported.
A strength of this study is the inclusion of mechanism data, which is lacking in most injury databases. However, like reports from other injury databases, this study is limited by an absence of information on training characteristics at the time of injury such as the level or intensity of participation. For example, the larger proportion of injuries in the 10–19 years age-group may be due to them playing more often or having a greater training intensity than other older age groups. Shariff et al.
] reported that Malaysian national badminton players under 20 years old had the greatest proportion of injuries and suggested that this may have been due to a lack of experience or more aggressive style of play.
Limitations in our study as a result of incomplete injury mechanisms information in the ACC database were: (a) Whether the injury occurred during training or match play; (b) The period during training/match that the injury occurred; (c) The court area where the player was injured; (d) The players’ performance level or the intensity of their training/participation.