The epidemiology and aetiology of injuries in sailing.

Sailors are at risk of injury and an understanding of the risks and causes of injury are important in helping to reduce their frequency and severity. Injuries are specific to the class of sailing. In elite Olympic-class sailing the incidence of injury is approximately 0.2 injuries/athlete/year, with the lumbar and thoracic spine and the knee most commonly injured. Poor hiking technique and inadequate leg strength are thought to predispose the knee to injury. Injuries in novice and recreational sailing are predominantly acute in nature with contusions and abrasions typically occurring as a result of collisions with the boom or other equipment during manoeuvres. The only report of injuries in Paralympic-class sailing found a high rate of approximately 100 injuries/1000 days of sailing, likely due to severe sailing conditions. The majority of injuries were chronic in nature, predominantly sprains and strains of the upper extremity. The risk of windsurfing injury ranged from 1.1 to 2.0 injuries/person/year, with the majority of injuries being acute, typically due to impact with equipment. Severe injuries are frequent, with competitive male windsurfers often admitted to hospital for treatment. Chronic lower back injuries are also common in windsurfers and may be related to prolonged lordosis (lumbar extension) of the spine while 'pumping' the sail. In professional big-boat sailing, America's Cup studies have reported an incidence of approximately 2.2 injuries/1000 hours of sailing, with one study reporting a higher incidence of injury during fitness training sessions (8.6 injuries/1000 hours of fitness training). The main cause of injury seems to be non-specific overuse, with joint and ligament sprains and tendinopathies being the most common. Grinders and bowmen are at greatest risk of injury, with the repetitive nature of 'grinding' a contributing factor. In round-the-world offshore racing, 1.5 injuries/person/round-the-world race (amateur), and 3.2 injuries/person/race (professional) have been reported, with the majority being impact injuries (e.g. contusions, lacerations, fractures and sprains). Helmsmen experience mostly upper-limb overuse injuries as a result of 'steering', while mastmen and bowmen are at greater risk of acute injuries. Illnesses and non-injury-related complaints account for a large proportion of medical conditions in these events. Sailors of all classes and abilities seem to be at risk of injury, particularly from acute impacts with equipment that might be reduced by wearing protective clothing and more ergonomic boat design. High repetition activities, such as hiking, pumping, grinding and steering, are major causes of overuse injury in experienced sailors. Informed coaching of correct technique and appropriate progression of physical and technical developments are required. Competitive sailors should undergo regular health screening with specific strengthening of high-risk muscle groups, synergists and stabilizers. The scarcity of analytical studies of sailing injuries is a major concern, and there is a need for thorough prospective studies.