The 2024 Olympic and Paralympic Games in Paris are expected to feature a diverse range of sports with exciting new additions, including breaking (breakdancing), surfing, skateboarding, and sport climbing.
As the excitement surrounding the Games builds, it is crucial to address sports-related injuries, particularly the risk of head injury. Concussions are a form of traumatic brain injury that can result from impacts to the head or body, leading to a range of symptoms. Understanding the prevalence and management of sports-related concussions is vital for ensuring the well-being of Olympic athletes and fostering a safer competitive environment.
This article reviews the different high-risk sports featured in the 2024 Olympic and Paralympic Games while examining the prevalence rates of concussions in these events. By doing so, we hope to highlight the importance of concussion awareness, concussion reporting, and injury prevention strategies.
Boxing is among the sports with one of the highest risk of concussions. Boxers face potential head injuries from repetitive blows to the head, jabs, hooks, and uppercuts. Soligard et al. (2017, 2023) found boxing had the highest number of concussions across all sports at both the Rio de Janeiro 2016 Olympic Summer Games (58%) as well as the Tokyo 2020 Summer Olympics (23%).
Preventing concussions in boxing requires adherence to safety protocols and techniques. Essential protective gear in boxing includes padded gloves, head protection for amateur boxers, and mouthguards. In addition to gear, rigorous medical support is critical. Ringside physicians and medical staff are always present during bouts to assess and respond to suspected concussions. Education on concussion symptoms and the importance of concussion reporting is pivotal in boxing. Boxers, trainers, and referees are all trained to recognize signs of brain injury and to prioritize health over competition.
Combat sports like judo, wrestling, and taekwondo have inherent concussion risks due to the nature of close combat, throws, strikes, and physical takedowns. Head injury can occur from direct blows, falls, or accidental contact with the mat or another opponent.
Lystad et al. (2021) examined the incidence of injuries among athletes in Olympic combat sports, analyzing data from 7,712 athlete exposures across three consecutive Olympic Games. Their research highlights that concussions were a significant concern in these sports, accounting for 3% of all injuries. In addition, Soligard et al. (2023) found that 15% of all concussions occurred during combat sports at the Tokyo 2020 Summer Olympics.
Preventing concussions in combat sports requires proper training techniques, ensuring athletes understand how to execute and receive movements safely. Additionally, education is critical—athletes, coaches, and referees must be well-versed in recognizing concussion symptoms and the importance of reporting them immediately.
Concussions in cycling can occur across all disciplines, including road cycling, track cycling, mountain biking, and BMX racing, due to falls, collisions, or crashes. A study by Engebretsen et al. (2013) sheds light on the prevalence of concussions in cycling during the London 2012 Summer Olympic Games. The study found that cycling presented a significant risk for head injury, primarily due to high-speed crashes and falls. In addition, Soligard et al. (2017) showed similar findings from the Rio de Janeiro 2016 Olympics and the Toyko 2020 Summer Olympics (Soligard et al., 2023), with cycling being one of the sports with reported head injuries.
These studies emphasized the critical role of protective gear, such as helmets, in mitigating the risk of severe head injuries such as skull fractures. Furthermore, they underscored the importance of rigorous training programs to enhance athletes’ skills in safely avoiding crashes and handling high-speed scenarios.
Equestrian sports, which encompass activities such as show jumping, dressage, and eventing, present notable risks for concussions due to the inherent interactions between the rider and the horse. Concussions in equestrian sports are commonly caused by falls from the horse, which can occur for various reasons, including the horse stumbling, refusing a jump, or getting spooked. These falls can result in riders hitting the ground or being thrown, leading to significant head and neck injuries. Gates and Lin (2020) found that concussions were the most common head injury for equestrians.
Football, commonly known as soccer, is primarily a non-contact sport. However, it has a notable prevalence of concussions due to various in-game scenarios, such as player collisions, heading the ball, and accidental falls. Studies by Soligard et al. (2023) and Pfister et al. (2016) highlight that concussions in soccer predominantly happen during aerial duels and physical challenges.
Studies looking at injury surveillance data during the 2004 Summer Olympic Games (Junge et al., 2004), the London 2012 Summer Olympic Games (Engebretsen et al., 2013), and the Tokyo 2020 Summer Olympic Games (Soligard et al., 2023) all found that soccer had one of the highest incidence rates of reported concussions.
Preventing concussions in soccer involves educating players on proper heading techniques and enforcing rules against dangerous plays. Additionally, having effective concussion protocols in place is crucial for early detection and management of head injuries.
Field hockey carries a significant risk for concussions due to the use of hard sticks and balls and the high-speed nature of the game. Players are vulnerable to concussion from being struck by sticks during contested plays, balls flying off the pitch, or collisions with other players.
Junge et al. (2004) analyzed sports-related concussions during the 2004 Olympic Games. They found that field hockey had a substantial incidence rate of concussions, primarily resulting from player collisions and impacts with sticks and balls. In addition, Barboza et al. (2018) conducted a systematic review revealing that concussions accounted for a significant proportion of total injuries in field hockey, emphasizing the high-risk nature of the sport.
These findings highlight the need for educational programs on safe play techniques and the implementation of stringent safety protocols to protect athletes. Coaches must stress the importance of safe playing techniques, including keeping sticks low to avoid accidental head strikes and ensuring players are alert and aware of ball movements.
While the overall risk of concussion in handball is lower compared to more contact-heavy sports like rugby, it still presents a notable risk due to collisions between players, accidental falls, and impacts with the hard playing surface.
Junge et al. (2004) found that handball had a significant incidence rate of concussions during the 2004 Olympic Games. The study highlighted that the combination of rapid, unexpected direction changes, physical contact, and high-speed play increases the likelihood of head injuries. Moreover, both Soligard et al. (2017) and Steffen et al. (2021) documented comparable high rates of concussions in handball during other Olympic Games.
Rugby is a physically intense sport that involves a high degree of contact between players, making it one of the sports with the highest risks for concussions. The nature of the game, which includes tackles, scrums, and rucks, inherently exposes players to the possibility of head impacts and collisions. Concussions can occur from direct head-to-head contact, impacts with the ground, or blows from other players’ elbows or knees during tackles and rucks.
Soligard et al. (2017) revealed that rugby had a high concussion incidence rate among all sports analyzed during the Rio de Janeiro 2016 Olympic Summer Games (17%). Complementing this finding, Steffen et al. (2021) investigated injuries at the 2018 Youth Olympic Summer Games, while Soligard et al. (2023) examined concussion data during the Tokyo 2020 Summer Olympics. Both studies consistently highlighted rugby’s notably high concussion rates, confirming the sport’s significant risk for head injuries across different Olympic events.
Preventing concussions in rugby begins with proper technique and training. Players are taught to safely tackle and engage in contact situations, emphasizing body positioning to minimize head impacts. Rugby governing bodies enforce rules that penalize dangerous plays and high tackles for discouraging behaviors that increase concussion risks.
Water polo carries notable concussion risks due to the physicality of the sport, including contact between players and accidental strikes to the head with the ball or other players’ limbs. The fast-paced and competitive nature of the game increases the likelihood of head injuries.
Junge et al. (2004) provided an extensive analysis of injuries during the 2004 Olympic Games, and their findings found that physical contact and accidental blows to the head during water polo were the primary causes of concussions. This study underscores the need for effective preventive measures, including stricter enforcement of rules to minimize violent impacts, improved protective gear, and comprehensive concussion management protocols.
The 2024 Olympic Games will introduce several new sports, including breaking, sport climbing, surfing, and skateboarding. Of these new sports, skateboarding, and surfing stand out for their elevated risk of concussions. Studies have indicated that both sports have higher concussion rates compared to many traditional Olympic events.
Skateboarding, with its thrilling tricks and high-energy maneuvers, poses a considerable risk for concussions. McIntosh et al. (2021) demonstrated that competitive skateboarding carries an elevated risk for sport-related concussions, primarily due to frequent falls and impacts with hard surfaces.
The introduction of skateboarding in the Toyko 2020 Olympics showcased the high-impact nature of the sport. Many athletes experienced significant falls and collisions, leading to a notable incidence of concussions (Soligard et al., 2023). In particular, high-speed maneuvers and complex aerial stunts were identified as critical contributors to head injuries. These findings call for an emphasis on safety measures, including helmets and padded gear, and athlete education on fall techniques to mitigate the risks of concussions.
Surfing poses a significant risk for concussions, primarily due to wipeouts, in which surfers can be thrown onto their boards, the ocean floor, or other surfers. The powerful waves and unpredictable nature of the ocean environment add to the risk of head impacts. Nathanson et al. (2002) analyzed data from surfers and found that concussions accounted for 9% of all reported injuries.
These findings indicate the importance of implementing safety measures such as using helmets explicitly designed for aquatic sports and promoting awareness of safe surfing techniques. Educating surfers about the risks and encouraging practices to minimize head injuries can help reduce the concussion rate.
| Sport | Total Number of Concussion over Past 5 Olympics | Concussion Incidence Over Past 5 Olympics (% of all concussion) |
| Boxing | 15 | 24% |
| Football (soccer) | 14 | 22% |
| Combat Sports | 7 | 11% |
| Cycling (BMX/MTB) | 5 | 8% |
| Field hockey | 5 | 8% |
| Rugby | 4 | 6% |
| Handball | 3 | 5% |
| Skateboarding | 2 | 3% |
| Water polo | 2 | 3% |
| Baseball/Softball | 2 | 3% |
| Athletics | 1 | 1.6% |
| Modern Pentathlon | 1 | 1.6% |
| Basketball | 1 | 1.6% |
| Canoe | 1 | 1.6% |
The Paralympic games encompass various sports, varying from high-impact events like wheelchair rugby to endurance challenges like para-triathlon. The unique dynamics of para-sports often require modified techniques, equipment, and safety protocols, which can influence the nature and frequency of head injuries. Understanding and addressing the specific risks of concussions in Paralympic sports is essential to safeguard the physical and mental health of these athletes.
Lexell et al. (2021) examined the prevalence of concussions among elite Paralympic athletes over one year. Findings from their illness surveillance system indicated that para-athletes are indeed susceptible to concussions, with varying incidence rates across different sports. While winter Paralympic sports, such as para-alpine skiing and para-ice hockey, are discussed for their high risk of concussions, several summer Paralympic events are also noted. Specifically, wheelchair events like wheelchair rugby, blind football, goalball, para-cycling, para-triathlon, para-judo, and para-swimming are rated moderate to very high risk for concussion injury. They also demonstrated that female athletes had a higher incidence of concussions compared to their male counterparts.
Wheelchair sports pose significant risks for concussions among Paralympic athletes. This increased risk can be attributed to several factors inherent to wheelchair sports. Paralympic athletes often have decreased or altered muscle control, which reduces their ability to protect themselves effectively during collisions or falls. The design and setup of wheelchairs can also contribute to these risks; wheelchairs can be unstable, with a higher center of mass that exacerbates tipping over during fast, dynamic movements.
Sá et al. (2022) demonstrated that concussions accounted for 24% of all injuries sustained by wheelchair basketball players, with the majority occurring as a result of falls or collisions. Interestingly, Kissick and Webborn (2018) found that wheelchair basketball athletes who did not use a wheelchair regularly had a higher rate of concussions than habitual wheelchair users. These athletes may have less control and poorer balance in their chairs.
Wheelchair rugby combines elements of rugby, basketball, and handball, making it one of the most physically intensive para-sports. The game’s aggressive play, high-speed collisions, and rapid direction changes place athletes at a considerable risk for concussions.
According to Lexell et al. (2021), wheelchair rugby players are subject to a high prevalence of concussions, with injury rates comparable to those seen in many able-bodied contact sports. The primary mechanisms of concussions in wheelchair rugby include direct head-to-head or head-to-wheelchair contact during collisions and falls from the wheelchair under high-speed or high-stress conditions.
Wheelchair track racing is another Paralympic sport where athletes face the risk of concussions. While the sport is generally perceived as less contact-intensive compared to others, like wheelchair rugby, concussions can still occur primarily due to high-speed crashes, collisions, or falls during races. Kissick and Webborn (2018) examined injury patterns among wheelchair-track athletes. They identified concussions as a notable concern, particularly in high-speed and tactical racing situations where sudden shifts in movement and unforeseen interactions can lead to accidents.
Research has shown that Paralympic athletes with vision impairment account for 62% of all concussions (Lexell et al., 2021). Teodoro et al. (2024) highlight the vulnerability of visually impaired athletes to concussions due to the inherent challenges of navigation and spatial awareness in competitive environments. The authors advocate for targeted injury preventive strategies to ensure the safety of visually impaired athletes. For example, in the study by Lexell et al. (2021), many athletes reported that their concussion could have been prevented with more guides, tappers (in swimming), and better knowledge and awareness among coaches. By addressing these gaps, the sporting community can better protect these athletes.
Visually impaired athletes compete in various sports at the Paralympics. Those with a high potential for concussion include:
Para-swimming accommodates paralympic athletes with various disabilities, including visual impairments, cerebral palsy, amputations, and spinal cord injuries. Despite being a non-contact sport, the risk of concussions in para-swimming should not be overlooked. Concussion risks primarily arise from accidental collisions with pool walls, lane ropes, or other swimmers during races.
Singh et al. (2024) found a high incidence of concussions in para swimming. These concussions may be attributed to other underlying medical conditions. These conditions can often alter swimming biomechanics and impact motor control and coordination. Such alterations may lead to inaccurate perceptions of their surroundings, impairing their ability to control speed and direction. Consequently, para swimmers may experience an increased risk of collisions with pool walls or other swimmers. To mitigate these risks, using tappers—assistive devices operated by coaches to signal visually impaired swimmers when to turn or finish—is crucial.
Due to a lack of data in Paralympic athletes and concussion incidence rates, Kissick & Webborn, (2018) provide the table below highlighting the “best estimate” of concussion risk across different paralympic sports with risk rating: 1 (low) to 5 (high).
| Sport | Concussion Risk Rating |
| Cycling (road) | 5 |
| Para-Triathalon (bike) | 4 |
| Blind Football | 4 |
| Cycling (track) | 3 |
| Goalball | 3 |
| Para Athletics (track) | 3 |
| Wheelchair Rugby | 3 |
| Wheelchair Basketball | 2 |
| Para Swimming | 2 |
| Para Judo | 2 |
Despite the growing recognition of concussion risks in Paralympic sports, there remains a significant gap in the incidence data on concussions among Paralympic athletes. Current studies and illness surveillance systems often lack comprehensive data that details the frequency and context of concussions within this population.
Derman et al. (2018) examined injury rates at the Rio 2016 Summer Paralympic Games. Their research highlights that concussions were a significant concern but may be under-reported in this population. This absence of detailed information calls for more research and epidemiological data to better understand the factors contributing to concussions in Paralympic sports.
Evaluating a concussion in athletes with underlying disabilities presents intricate challenges. Disabilities such as cerebral palsy, which affect motor control and coordination, can obscure the typical signs of a concussion, making diagnosis more complex.
In addition, current concussion assessment guidelines and tools, such as the Sport Concussion Assessment Tool 5 (SCAT5), are widely used to diagnose and manage concussions in general athletic populations. However, these tools may not be entirely applicable or practical for some para-athlete populations. The SCAT5, for example, includes various cognitive and physical tasks, such as balance tests and memory recall, which may not accurately reflect the abilities or limitations of para-athletes with specific disabilities. For instance, individuals with spinal cord injuries or amputations may find specific balance tests irrelevant or impossible to perform. At the same time, those with cerebral palsy may struggle with tasks requiring fine motor control.
Moreover, the neurocognitive components of these assessments were developed based on norms derived from able-bodied athletes, which could lead to inaccurate baselines and misinterpretations when applied to para-athletes. It is crucial to adapt these assessment tools better to consider the unique needs and conditions of para-athletes. Ensuring the validity of these assessments across diverse para-sport populations will enable more accurate diagnoses. To address these limitations, further research and development are needed to create more inclusive and adaptable concussion assessment tools that accurately reflect the capabilities and challenges faced by para-athletes.
Managing concussions in para-athletes requires a tailored approach that takes into account the specific impairment and the nature of the sport involved. For example, athletes with amputations or mobility impairments necessitate adapted physical assessments that can accurately measure their balance and coordination without relying on standard tests that may not be applicable.
Moreover, athletes’ recovery process may vary depending on their underlying medical condition. For instance, an athlete with cerebral palsy might experience slower neurocognitive recovery due to pre-existing motor control challenges, requiring a more conservative return-to-play timeline. Regular and thorough pre-season medical screenings and Concussion Baseline Testing can help establish baselines for comparison, aiding in the accurate diagnosis and management of concussions and clearance for return to sport.
Safety equipment plays a crucial role in minimizing the risk of severe brain injuries and external trauma (ie., skull fractures), in both Olympic and Paralympic sports. Helmets, padding, and other protective gear are designed to absorb impact and provide support (Knight et al., 2021). However, it should be noted that research has shown that helmets and headgear do not necessarily prevent concussions. Furthermore, in some cases the perception that helmets prevent concussions can lead to more aggressive play and riskier behavior (Menger et al., 2016).
Training and education are fundamental to concussion prevention in Olympic and Paralympic sports. Athletes, coaches, and medical staff must be well-versed in proper techniques, safety protocols, and the signs and symptoms of concussions. Additionally, educational programs raise awareness about the importance of reporting injuries and seeking immediate medical attention.
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Each sport has specific safety regulations tailored to its unique demands. These regulations ensure that all participants adhere to guidelines designed to protect their well-being. For example, in para judo, rules prohibit dangerous moves that could lead to head injuries. Similarly, in Olympic sports such as rugby, players are penalized for tackles that make contact with an opponent’s head or neck area. Referees and officials monitor compliance with these regulations.
In conclusion, the commitment to athlete safety, particularly regarding concussion prevention and management, is indispensable for the success of the 2024 Olympic and Paralympic Games. By fostering a culture of awareness, we can protect our athletes and ensure that they compete at their highest levels in a safe sporting environment.
If you are a rehab therapist wanting to learn more about concussion awareness and rehabilitation, click here for more information on the Complete Concussions Training Course for Rehab Professionals. If you would like to speak with someone about training and our clinical network, email info@completeconcussions.com
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