Sharmella Roopchand-Martin¹, Akash Dhanai², Ruchelle Brown-Calvert¹, Akshai Mansingh^1
1Faculty of Sport, The University of the West Indies, Mona
²Felicity Medical Clinic, Chaguanas, Trinidad

Corresponding Author:
Dr. Sharmella Carol Roopchand-Martin
Email: [email protected]

DOAJ: 48b2e9d1c29945a5aae898e3e5e42d52
DOI: https://doi.org/10.48107/CMJ.2025.06.003
Published Online: June 30, 2025

Copyright: This is an open-access article under the terms of the Creative Commons Attribution License which permits use, distribution, and reproduction in any medium, provided the original work is properly cited.

©2025 The Authors. Caribbean Medical Journal published by Trinidad & Tobago Medical Association

ABSTRACT
Objective: This study sought to determine the prevalence and epidemiology of self-reported injuries from recreationalsport and exercise participation in the general adult population of Trinidad and Tobago.
Methods: A cross-sectional survey was conducted via structured telephone interviews. Quota random sampling was done using the Regional Health Authorities’ geographical distribution. Phone numbers were randomly selected from the 2019 print telephone directory using computer-generated random numbers that were matched to the names counting from the top of the page for each zone. Persons 18-years and older from each household, who met the inclusion criteria, were invited to participate. Data on self-reported injuries from July to December 2019 was captured.
Results: A total of 1035 persons (58% males, 42% females) completed the study. The mean age was 45.0 years ± 19.8years. Major ethnic groups were represented, namely Indian, African, and Mixed.  Fourteen percent of the sample had sustained an injury from participating in sport or exercise during the time of interest. The estimated probability of sustaining an injury during recreational sport and exercise was 0.27% or 27 injuries per 10,000 occurrences of exercise activity. Injuries were more prevalent in younger persons, males and those with a higher level of education. Most were engaged in weights/resistance training at the time of injury.
Conclusion: The pattern of injury from participation in recreational sport and exercise was similar to that of other countries, with prevalence being highest among young males and those with higher education levels. These injuries should be a public health concern and consideration should be given to employing sports medicine specialists at primary care facilities and driving injury prevention campaigns alongside physical activity ones.
Keywords: physical activity, recreational injuries, overuse syndromes, traumatic injuries

INTRODUCTION
The benefits of physical activity are so well documented that international organizations have prioritized increasing participation in sport and exercise across all ages, genders, abilities and socioeconomic groups.^(1,2,3) Over 50% of the adult population of Trinidad and Tobago do not meet the required levels of physical activity for health benefits.⁴ This means that more work must be done to get persons involved in recreational sports, exercise and movement. As we do this, it is important to note that engagement in sport and exercise carries a risk of injury. These injuries will incur costsand place a burden on the health care system. It is important to track as well as understand the injury patterns associated with recreational sports and exercise so that appropriate policies and procedures can be implemented to mitigate them and health systems can thus be adequately prepared to manage injuries from a more physically active population.

Literature related to injury from engagement in recreational sport and exercise is relatively sparse and differences in methodological approaches make it difficult to draw comparisons. Many of the reports are based on hospital data which does not separate professional sport participation from recreational participation. Definitions of sport and exercise injury are varied or not stated. Some papers are based on participant self-report of injury, whilst others report physician-diagnosed injury extracted from hospital records. Duration of studies vary from a minimum of three months’ recall to retrospective ten-year trends.

Additionally, much of the focus has been on children rather than adults. Despite these challenges, some trends are still observed and the literature indicates that sports (both recreational and competitive) and exercise injuries are areas of concern.

In many developed countries, sport and recreational injuries account for a large percentage of young people presenting to emergency departments.^(5-17) Results of a national survey for the United States of America (USA) (inclusive of persons 5 years and older) reported an average of 8.6 million sport and recreation-related injuries per year from 2011 to 2014.⁵ Whilst the incidence of sport and exercise injuries decreased dramatically during the heights of the 2020 COVID-19 pandemic, an upward trend was seen once activity resumed.⁷ Data from a Dutch national survey of persons younger than 50 years reported 10 injuries per 10,000 hours of sport participation.¹¹ Exercise was not considered in this study. A Danish national survey reported sport injury prevalence of 18.4% in persons aged 15 years and older.¹⁵ This survey included injury from recreational and professional sport, as well as exercise. A national health survey for Germany reported an annual injury incident rate of 5.6% from recreational sport and exercise and ranked injuries from playing sport as the second most common type of accident in the country.¹⁷ No national surveys were identified for low-and-middle-income countries.

Hospital data from Australia has shown approximately 77, 000 hospitalizations for a sport or leisure related injury over afive-year period⁹ and increases in the prevalence of sport and exercise injuries over time.^(9,10) Hospital records, spanning ten years, from two areas in Cameroon showed 1.12% of all trauma cases to be sport-related, with 59.7% occurring during recreational sport.¹⁸ One hospital in Oman reported prevalence rates ranging from 1.6% to 14.9% over a one-year period.²⁰ Differences in ease of access to healthcare could account for the variation in prevalence rates for hospital data.

The global trend shows a higher prevalence of injury from sport and exercise amongst younger persons and males.^{(5,7,9,10,15-20)} For the USA, 65% of the injuries prior to COVID-19 were reported in the 5 to 24-year age group, with males more affected than females.⁵ This trend continued post COVID-19 lockdowns, with injury rates for males being almost double that of females (2,373,621 males, 1,257,781 females).⁸ In Queensland, hospitalization for injury from sport or recreation was higher in males (130.6/100,000 population) than females (28.9/100,000)⁹ and in New South Wales, the estimated rate of hospitalization for males was almost triple that for females.¹⁰ Data from China, showed a higher prevalence of sport-related injury in male college students (48%) than females (32%).²⁰ In Cameroon, over 80% of injuries occurred inyoung males¹⁸ and in Oman, young men in their twenties and thirties accounted for most injuries.¹⁹

When looking at the prevalence of injury as a percentage of the total population the rate in males was higher than females; however, when examined by group, the literature points to no difference in the proportion of injuries among males and females.²¹ Rather the gender differences in injuries appeared to be more related to type and body area.^(20,21) Women for example appeared to be more prone to anterior cruciate ligament injuries and ankle injuries.^(21-23) The higher prevalence of injury in younger persons may be due to immaturity of the musculoskeletal and neuromuscular systems.²⁴

The type of sport and recreational activity contributing most to injury varies depending on the geographical location. Emergency department data for the USA showed American football followed by basketball to be most common cause of injury in young males while gymnastics and cheerleading for females.⁶ Post-COVID-19 lockdowns, the main activity associated with injury in the general population was general exercise (aerobics, weights, running).⁷ In Australia, the largest percentage of injuries (24.3%) were associated with playing team sports involving a ball, with rugby leading the list.⁹ In Europe, Cameroon and Oman playing football accounted for most injuries.^{(11,13,14,15,18,19)} Running was anothercommon cause of injury in these regions.^{(11,13,14,18,20)} In China, running, badminton, basketball and bicycling were the primary activities associated with injuries in collegiate students²⁰ and in Chile, basketball followed by football were common sports accounting for injury in college students.²⁵

Most of the injuries reported for the USA were of the lower limb (42%) followed by upper limb (30.3%) and the head and neck (16.4%).⁵ Lower limb injuries were also very prevalent in the Netherlands (78.6%), Cameroon (47.2%), Oman (63.5%) and Chile (63%).^{(11,18,19,25)} Sprains and strains tend to account for most sport and recreational injuries.^(5,8,18)An exception to this was seen in Cameroon where fractures accounted for most injuries presenting to the hospitals.¹⁸Cultural differences in people’s perception of type of injuries that require hospital attention may account for this difference.

There has been a growing awareness of the socioeconomic disparities in relation to engagement in physical activity.^(26-29) Across Europe and the USA, education has been one of the more stable indicators of engagement in physical activity. Studies have shown that persons with a higher level of education are more likely to be engaged in physical activity and thus may present as having a higher injury prevalence.

Data for the Caribbean is sparse; however, one study examined hamstring injuries among persons presenting to the University of the West Indies Sports Medicine Clinic.³⁰ Of the 134 injuries presenting to the clinic, 62.4% occurred in the age group 17 to 21 years and most were in males (73.6%). Track and field and soccer were the two largest contributors to the occurrence of a hamstring injury.³⁰

There are known long-term sequelae of acute musculoskeletal injuries such as re-injury, chronic pain, degenerative changes, reduced quality of life, time off from work, reduced performance and psychological conditions.^(31-33) Added to this are the economic costs associated with treating these injuries. For the period 2018 to 2019, Australia reported health costs associated with injuries from engaging in physical activity to be 1.2 billion dollars.³⁴

This represented approximately 11% of the total health costs from injuries for the year.³⁴ Soft tissue injuries accounted for 25% of the cost followed by fractures.³⁴ Concerns regarding the projected health costs for treating Osteoarthritissecondary to sport and exercise injuries sustained in early years have led to advocacy for population wide injury prevention strategies, led by sports medicine practitioners.^(35,36)

Like other areas of the world, the Ministry of Health in Trinidad and Tobago has been encouraging the population to exercise. As engagement in sport and exercise increases, so too does the occurrence of injury. Obtaining data on theprevalence of injury from participation in recreational sport and exercise can guide the planning of prevention programs, allocation of resources and investment in developing specialists in sports medicine who may be better equipped to manage these injuries. This study sought to determine the prevalence and epidemiology of recreational sport-and-exercise-related injury in the general population of Trinidad and Tobago.

METHODOLOGY
Study setting and design
Following approval from the Ethics Committee of the University of the West Indies Mona Campus and the Ministry ofHealth, Trinidad and Tobago (TT), a cross-sectional survey was conducted in Trinidad and Tobago. The health system of Trinidad and Tobago is organized into five regional Health Authorities (four in the island of Trinidad and one in the islandof Tobago). The population density is different for each regional authority and proportional sampling was done to ensure adequate representation from each region. The targeted sample was 1039 adults (40% for the southwest region, 25% for the north central region, 22% for the northwest region, 8% for the eastern region and 5% for Tobago).

For this study, injury from recreational sport or exercise was defined as any injury occurring because of direct contact ornon-contact trauma during the warmup, activity phase or cool down of the sport/exercise that affected participation. Flare up of any overuse/degenerative pathologies, clearly known to be associated with the specific activity that persons were engaged in, was also considered an injury. The injury had to be symptomatic within the past 6 months (at the time of interview) even if the onset was earlier.

Sport in this study referred to playing sport for exercise, fun, health or social interaction and not organized tournaments or structured competition for medals or trophies. Exercise was defined as a structured physical activity with the intention of having fun or improving health.

Target population
The target group for the study was adults (eighteen years and older), living in the Republic of Trinidad and Tobago, whohad been involved in recreational sport or exercise at some time during the last six months of 2019. Persons who competed in sports at professional or semi-professional levels were excluded. Anyone who was a national athlete was also excluded.

Sample Selection
Telephone numbers listed under the different health authority zones were selected from the 2019 print copy of the telephone directory using a computer-generated random number sequence to match with names counting from the top of the list for each zone. Calls were made to landlines only and if there was no answer, the next consecutive number in the sequence was selected.

Only one attempt was made to each number selected. Calls were made between the hours of 8:00 am to 6:00 pm to capture persons after work whilst still respecting personal time. Once the phone was answered the researchers introduced themselves and verified that they were speaking to an adult in the household. They were taken through the informed consent form for the study and at the end if they agreed to take part, the interview proceeded using the questionnaire developed by the researchers. For those who were interested but needed a return call, this was scheduled.

The option was given to all adults in the household who met the criteria to participate in the study. If a child answered the phone, the researchers asked to speak to the head of the household. The data collected was reflective of the last sixmonths of 2019, just prior to the full onset of the 2020 COVID-19 pandemic. Data collection was done in March 2020.

Instrument
Data was collected using a questionnaire that was formulated by researchers based on the review of literature and the researchers’ knowledge on sport and exercise injuries (see supplement). Questions were asked to assess the sociodemographic profile of the subjects to assess how often they took part in sport or exercise activities and to determine whether they had any injuries that could have been due to these activities. Open ended discussions helped the researchers with categorizing injuries under type and affected body area. Questions also probed the level of health care accessed, treatment modalities and outcome. All injury data was based on participants’ self-reporting. The instrument was pre-tested for ease of administration and clarity and expert review of the instrument was done by two sports medicine practitioners prior to use.

Data Analysis
Statistical analysis was executed using IBM SPSS statistical software version 19 for Windows. The minimum number of days that the person engaged in exercise per week was used to estimate the total episodes of exercise over the six-month recall time. This was used to calculate the probability of injury from a sport/exercise episode. A student’s t-test was used to evaluate differences in the mean age of those with and without injury. The Chi-square test was used to assess for differences in occurrence of injury based on geographical location, ethnicity, education level and gender.

Open ended questions were categorized into specific headings based on the information provided and descriptivestatistics (means and percentages) used to present the data. Statistical tests were conducted at an alpha level of 0.05.

RESULTS
Table 1 shows the profile of the study participants.  One thousand and thirty-five (1035) people (58.4% males, 41.6% females) participated in this study. Participants’ age ranged from 18 to 92 years (mean = 45.0, SD = 19.8 years). All participants had been engaged in recreational sports or exercise during the last six months of 2019 (July to December 2019). The largest representation was from the Southwest Regional Health Authority (40%). Almost half of the sample were of East Indian descent (46.4%) and over 50% were educated up to the tertiary level.

Table 1: Profile of study participants (N = 1035)

Injury profile
One hundred and forty-five persons (14%) reported having sustained an injury from recreational sport or exercise participation. There were 53,400 total estimated episodes of exercise over the six-month study period leading to the estimated probability of sustaining an injury during recreational sport and exercise being 0.27% or 27 injuries per 10,000 occurrences during exercise activity.

Participants who sustained injuries were significantly younger (p < 0.001) than those who did not sustain an injury (Table 1). The proportion of males who sustained injuries were higher than that of the females, but this was not statistically significant (p = 0.104). Statistically significant differences (p < 0.001) in injury prevalence based on ethnicity and education were found (Table 1). Injury prevalence rates were found to be lowest in those of African descent (7.2%) and highest in those of “other” origins (22.3%). The injury prevalence rate for those with tertiary level education was more than twice that of those with primary and secondary level education.

Of the total number of persons who sustained injuries, the largest proportion occurred in males (64.1%), those of East Indian descent (55.2%), those living in the South-West Health Authority zone (42.8%) and those educated up to tertiary level (77.9%).

Injury Presentation
Table 2 shows the injury presentation and management. It is seen that lower limb injuries were most common (40.0%) followed by upper limb (30.3%). The most common type of injury was a non-contact sprain/strain (54.5%) and the most common treatment obtained was medication (71.7%).

Table 2: Injury presentation and management (n = 145)

There was wide variation in the type of activity people were engaged in when they sustained injury (Figure 1), but the most common cause was weight/resistance training (n=31; 21.4%). The second most common activity leading to injury was playing football (n=20;13.8%). All participants indicated that they had recovered from their injury.

Figure 1: Distribution of injury by activity participants were engaged in at the time of injury. Number (%).

DISCUSSION
Governments and health ministries across the world are expected to strategically increase engagement in physical activity among their population as a means of creating a healthier society.¹ Increasing participation in recreational sport and exercise are ways to do so; however, this is not risk free. Whilst data from other parts of the world has shown the prevalence of injury associated with sport and exercise to be a concern^(5-20), no data was identified for the Caribbean region that profiled these injuries in the general population. This type of data is required to guide strategic planning for minimizing adverse impact on people and the health care system. This study sought to determine the prevalence and epidemiology of injury from recreational sport and exercise participation in the general population of Trinidad and Tobago during the last six months of 2019.

A total of 1035 persons completed the study with 14% indicating they had sustained an injury during the six-month period. The estimated injury rate was 27 per 10,000 episodes of exercise. This finding was similar to that reported for other countries.^(8,15,17,19) In Denmark, injury prevalence among the general population was 18.4%¹⁵ and in Oman prevalence rates for those presenting to hospital ranged from 1.6% to 14.9%, depending on the time of year.¹⁹ It is important to note that hospital data may reflect lower injury prevalence since, not everyone with an injury will present to a hospital or the nature of the injury may not require hospital admission.

Like the studies reported in the literature^{(5,7,9,10,15-20)}, this study found that injury was more prevalent among younger persons and males. Lin and colleagues, as well as Matzkin and colleagues, all concluded that there are sex-related factors that contribute to an individual’s susceptibility to sports-related injuries.^(22,23) There is a more discriminate increase in skeletal muscle mass and corresponding strength in adolescent males.²⁴ This has been hypothesized to increase the risk of injuries due to collisions of greater intensity and impact.²⁴ Additionally, males tend to be more aggressive competitors and generally are exposed to longer training hours which may increase their injury risk.²¹

The higher prevalence of sport-related injury among individuals of higher educational status in this study is well aligned with the findings of research conducted in developed countries^26-29 Persons of lower educational levels are more likely to be engaged in jobs requiring manual labour resulting in them being fitter and thus more resilient to recreational sport injuries. Those with higher educational levels may also have more revenues at their disposal to pursue recreational sport and exercise that carry a higher risk of injury.

The anatomical distribution of injuries found in this study closely reflected those of previous studies, with most of the injuries confined to the lower limbs followed by the upper limb. Likewise, non-contact sprains and strains were most reported followed by overuse injuries and fractures.

Resistance training followed by playing football (soccer) was found to be the activity most associated with injuries in this study. This was similar to that reported for the national survey in the USA, where general exercise (aerobics, weight training, and running) accounted for most injuries.⁵ Except for Australia, where rugby was the main sport accounting for injury⁹, playing football was a leading cause of injury in the literature. Football and cricket are the two most popular sports in Trinidad and Tobago and more injuries will present from playing these sports simply because more people are playing them. We did not capture information regarding where resistance training was being done at the time of injury and what specific activity they were doing. However, education on proper technique and progression can minimize injury risk. Campaigns promoting exercise indicate that persons must engage in resistance training but do not necessarily provide guidance on how to do this safely.^(1,2) This should be addressed.

Many injuries from sports and exercise participation can be managed outside of a hospital setting. In the USA and the Netherlands, over a half of injured clients were seen by a general practitioner.^(5,12) In the Netherlands, approximately one-third of the population received advice and only a few were referred to the hospital.¹² In this study, approximately three-quarters of the participants who reported an injury within the previous six months were prescribed medications and approximately one-third received physiotherapy.

Many of the injuries reported in this study can predispose individuals to early degenerative conditions and are likely to re-occur leading to chronic problems if not properly managed. Sprains and strains, for example, require focused rehabilitation to reduce the risk of re-injury. Whilst all persons indicated they had fully recovered, more comprehensive testing may have revealed otherwise. The long-term sequelae of musculoskeletal injuries are more than pain and if notaware of them, the reporting of recovery may be over-expressed and consequences of the initial injury may go unnoticed. Good outcomes following injury are dependent on appropriate early diagnosis and management. Given the prevalence and types of injury seen in this study, one can postulate that there is a role for sports medicine specialists in the primary care setting.

The findings should be interpreted with some level of caution since this was a self-report, recall study and the possibility of a recall bias, which may have led to underreporting or over reporting of injuries, cannot be ruled out. The recall timewas six months, which was within the six-to-twelve-month range reported by other studies. This study looked at prevalence before the COVID-19 pandemic and given that some countries showed a profile change post COVID-19⁷, it would be important to collect current data for Trinidad and Tobago. Persons without landlines and those who could not be contacted during the hours of sampling were excluded and could have created some sample bias.

Overall, the findings of this study indicate that injury associated with participation in recreational sport and exercise should be of concern for the Ministry of Health in Trinidad and Tobago. Further investigations are required for a more in-depth understanding of these injuries. Playing surfaces, footwear, lack of protective gear and weather conditions all contribute to injury and understanding these additional factors are important in preparing successful injury prevention programs. Further investigation into the treatment options and determining whether it is in keeping with best practice, can support the importance of adequately trained sports and exercise medicine persons within the primary care setting.

Additionally, it would be useful for the Ministry of Health to examine injury trends following educational campaigns to promote physical activity. The Ministry should also consider partnering with sports medicine practitioners to deliver injury prevention education to complement their physical activity campaigns.

CONCLUSION
The findings of this study revealed that the public in Trinidad and Tobago have sustained injuries from engagement in recreational sport and exercise. Younger persons, males and those with a higher level of education are at a higher risk for injury. The findings imply a need for physical activity campaigns to be accompanied by injury prevention education anda role for sports and exercise medicine specialists in primary care and public health.

Acknowledgements: Not applicable
Ethical approval statement: Approval was obtained from the Ethics Committee of the University of the West Indies, Mona Campus and the Ministry of Health Trinidad and Tobago.
Financial disclosure or funding: This research was self-funded.
Conflict of interest: None
Informed consent: Verbal informed consent was obtained via phone call
Author contributions: Sharmella Roopchand Martin – conception, design, data analysis and drafting of manuscript. Akash Dhanai -conception, design, data acquisition, data analysis and drafting of the manuscript. Ruchelle Brown Calvert – conception, data analysis, drafting of the manuscript. Akshai Mansingh – interpretation of data and revision of manuscript

REFERENCES

1. World Health Global action plan on physical activity 2018–2030: more active people for a healthier world. (Geneva: World Health Organization, 2018).
2. Shilton T, Bauman A, Beger B, Chalkley A, et al. More People, More Active, More Often for Heart Health – Taking Actionon Physical Glob Heart. 2024 May 3;19(1):42. doi: 10.5334/gh.1308. PMID: 38708404; PMCID: PMC11067976.
3. International Olympic Cooperation with the UN, June 2024. Available from: https://olympics.com/ioc/cooperation-with-the-un.
4. Strain T, Flaxman S, Guthold R, et al. National, regional, and global trends in insufficient physical activity among adults from 2000 to 2022: a pooled analysis of 507 population-based surveys with 5·7 million participants. The Lancet. Global health, 12(8), e1232–e1243. Available from: https://doi.org/10.1016/S2214-109X(24)00150-5
5. Sheu Y, Chen LH, Hedegaard H,. National health statistics reports; no Hyattsville, National Center for Health Statistics. 2016.
6. Rui P, Ashman JJ, Akinseye Emergency department visits for injuries sustained during sports and recreational activitiesby patients aged 5–24 years, 2010–2016. Natl Health Stat Rep. 2019;2019(133):2010–2016.
7. National Safety Sport and recreational injuries. 2023. Retrieved August 21st 2022 Available from:https://injuryfacts.nsc.org/home-and-community/safety-topics/sports-and-recreational-injuries/
8. Mummery WK, Schofield G, Spence JC. The epidemiology of medically attended sport and recreational injuries in J Sci Med Sport. 2002 Dec;5(4):307-20. doi: 10.1016/s1440-2440(02)80019-6. PMID: 12585614.
9. Brimm D, Roe J, Warren J, et al. The epidemiology of sports and leisure-related injury hospitalisations in Queensland: Afive-year review. Injury. 2023 Apr 20:S0020-1383(23)00377-7. doi: 1016/j.injury.2023.04.035. Epub ahead of print. PMID: 37100695.
10. Finch CF, Mitchell R, Boufous S. Trends in hospitalised sport/leisure injuries in New South Wales, Australia-implicationsfor the targeting of population-focused preventive sports medicine efforts. J Sci Med Sport. 2011 Jan;14(1):15-21. doi: 10.1016/j.jsams.2010.03.009. Epub 2010 Jul 8. PMID: 20619733.
11. Schmikli SL, Backx FJ, Kemler HJ, et al.. National survey on sports injuries in the Netherlands: target populations forsports injury prevention Clin J Sport Med. 2009 Mar;19(2):101-6. doi: 10.1097/JSM.0b013e31819b9ca3. PMID: 19451763.
12. Baarveld F, Visser CA, Kollen BJ, et al. Sports-related injuries in primary health care. Fam 2011 Feb;28(1):29-33. doi:10.1093/fampra/cmq075. Epub 2010 Oct PMID: 20923967; PMCID: PMC3023075.
13. Pons-Villanueva J, Seguí-Gómez M, Martínez-González MA. Risk of injury according to participation in specific physicalactivities: a 6-year follow-up of 14 356 participants of the SUN cohort. Int J Epidemiol. 2010 Apr;39(2):580-7. doi: 10.1093/ije/dyp319. Epub 2009 Nov 6. PMID: 19897466.
14. Prieto-González P, Martínez-Castillo JL, Fernández-Galván LM, et al. Epidemiology of Sports-Related Injuries andAssociated Risk Factors in Adolescent Athletes: An Injury Surveillance. Int J Environ Res Public Health. 2021 May 2;18(9):4857. doi: 10.3390/ijerph18094857. PMID: 34063226; PMCID: PMC8125505.
15. Bueno AM, Pilgaard M, Hulme A, et al. Injury prevalence across sports: a descriptive analysis on a representative sample of the Danish population. Inj Epidemiol. 2018 Apr 2;5(1):6. doi: 10.1186/s40621-018- 0136-0. PMID: 29607462; PMCID: PMC5879036.
16. Hart P. Epidemiology of Exercise-Related Injuries Presenting to U.S Emergency Departments: 10-year Journal ofPhysical Fitness, Medicine and Treatment in Sports. 2017. 1(3). DOI: 10.19080/JPFMTS.2017.01.555562.
17. Schneider S, Seither B, Tönges S, et al. Sports injuries: population based representative data on incidence, diagnosis, sequelae, and high risk groups. Br J Sports Med. 2006 Apr;40(4):334-9; discussion doi: 10.1136/bjsm.2005.022889. PMID: 16556789; PMCID: PMC2586164.
18. Tankeng, LT, Djomo WN, Nana TC, et al. Epidemiology and clinical profile of sports injuries treated in the Douala General and Laquintinie Hospitals, in Cameroon: BMJ Open Sport & Exercise Medicine 2024;10:e002023.
19. Al-Atbi1 AY, Al Kashmiri A, Al Shaqsi S, Epidemiology of Sport and Active Recreation Injuries Presenting to a TertiaryEmergency Department in the Sultanate of Oman. Emerg Med (Los Angel) 2018, 8:1. DOI: 10.4172/2165-7548-8-1000363
20. Cai W, Chen S, Li L, et Gender-specific physical activity-related injuries and risk factors among university students in China: a multicentre population-based cross- sectional study. BMJ Open. 2020;10:e040865. doi: 10.1136/bmjopen-2020-040865
21. Ristolainen L, Heinonen A, Waller B, et al. Gender differences in sport injury risk and types of injuries: a retrospective twelve-month study on cross- country skiers, swimmers, long-distance runners and soccer J Sports Sci Med. 2009 Jun 1;8(3):443-51. PMID: 24150009; PMCID: PMC3763291.
22. Lin CY, Casey E, Herman DC, et al. Sex Differences in Common Sports PMR. 2018 Oct;10(10):1073-1082. doi:10.1016/j.pmrj.2018.03.008. Epub 2018 Mar 14. PMID: 29550413; PMCID: PMC6138566.
23. Matzkin E, Garvey Sex Differences in Common Sports-Related Injuries. NASN School Nurse. 2019;34(5):266-269. doi:10.1177/1942602X19840809
24. Patel DR, Yamasaki A, Brown K. Epidemiology of sports-related musculoskeletal injuries in young athletes in United Transl Pediatr. 2017 Jul;6(3):160-166. doi: 10.21037/tp.2017.04.08. PMID: 28795006; PMCID: PMC5532190.
25. Danes Daetz, C, Rojas Toro F, Tapia Mendoza   Lesiones deportivas en deportistas universitarios chilenos (Sports injuries in Chilean university athletes).2020; Retos, 38(38), 490-496.
26. Gidlow C, Johnston L. H, Crone D, et al. A systematic review of the relationship between socio-economic position and physical activity. Health Education Journal, 2006; 65(4), 338-367. https://doi.org/10.1177/0017896906069378
27. Beenackers A, Kamphuis C.B, Giskes K. et al. Socioeconomic inequalities in occupational, leisure-time, and transport related physical activity among European adults: A systematic review. Int J Behav Nutr Phys Act 9, 116 (2012). https://doi.org/10.1186/1479-5868-9-116
28. Scholes S, Bann D, Education-related disparities in reported physical activity during leisure-time, active transportation and work among US adults: repeated cross- sectional analysis from the National Health and Nutrition Examination Surveys,2007 to 2016. BMC Public Health. 2018 Jul 28;18(1):926. doi: 10.1186/s12889-018-5857-PMID: 30055611; PMCID: PMC6064072.
29. Fluharty ME, Pinto Pereira SM, Benzeval M, et al. Educational differentials in key domains of physical activity by ethnicity, age and sex: a cross-sectional study of over 40 000 participants in the UK household longitudinal study (2013-2015). BMJ 2020 Jan 20;10(1):e033318. doi: 10.1136/bmjopen-2019-033318. PMID: 31964672; PMCID: PMC7045199.
30. Brown Calvert R, Mansingh A, Roopchand-Martin S, et al. An epidemiological look into hamstring injuries in the Jamaican athletic population. Caribbean Medical Journal. 2020 Sep 27: 1-9. Doi.10.48017/CMJ.2020.08.005
31. World Health Musculoskeletal conditions. Retrieved February 19th 2024 Available from: https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions
32. Alessandrino F, Balconi Complications of muscle injuries. J Ultrasound. 2013 Mar 2;16(4):215-22. doi: 10.1007/s40477-013-0010-4. PMID: 24432177; PMCID: PMC3846951.
33. Melanson SW, Shuman VL. Acute Ankle Sprain. [Updated 2023 May 23]. In: StatPearls [Internet]. Treasure Island (FL):StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459212/
34. Australian Institute of Health and Economics of sport and physical activity participation and injury Retrieved Feb 19th 2024 from https://www.aihw.gov.au/reports/sports-injury/economics-of-sport-and-physical-activity/contents/summary
35. Finch C F, Kemp J L,Clapperton A The incidence and burden of hospital- treated sports-related injury in people aged15+ years in Victoria, Australia, 2004– 2010: a future epidemic of osteoarthritis? Osteoarthritis and Cartilage, 201523(7), 1138–1143. https://doi.org/10.1016/j.joca.2015.02.165
36. Öztürk S, Kılıç D. What is the economic burden of sports injuries? Eklem Hastalik Cerrahisi. 2013;24(2):108-11. doi: 10.5606/ehc.2013.24. PMID: 23692199