There were 100 different studies reporting data on sporting activities as a cause of SCI including both organized sports and recreational activities (table 9). 34 studies provided frequencies of SCI due to a specific sporting activity. The majority of studies were conducted in North America (Canada N=10; United States N=28) and Europe (N=24), and fewer reports were from Asia (N=16), Oceania (N=14), Africa (N=6) and South America (N=2). 16 studies reported on the frequency of SCI resulting from more than one specific sporting activity.
Studies reporting on sporting accidents as one cause of SCI among others include proportions ranging from a low of 0.2% in Tianjian, China (Ning et al. 2011) to a high of 23.8% in Russia (Silberstein and Rabinovich 1995). In the majority of these papers the proportion ranged between 7% and 16% (N=32 studies). Major sources of variation are likely due to differences in reporting techniques, inclusion criteria, and each study’s definition of sports. Some studies fail to define the sporting activities considered for their estimates of SCI due to sports. For example, in the United States, several studies (Acton et al. 1993; Calancie et al. 2005; Cosar et al. 2010; McCammon and Ethans 2011) reported the frequency of SCI due to diving separately while other studies include diving in their overall estimates of SCI due to sporting accidents.
The frequency of SCI due to sports is relatively low in China. Recent reports indicate SCIs due to sporting accidents range from 0.2% (Ning et al. 2011) to 1.1% (Li et al. 2011; Hua et al. 2013). A reason for the relatively low frequency is that individuals in China are less active in sports that could lead to a SCI (e.g. skiing, diving, rugby) than individuals in countries where sports participation is higher (Ning et al. 2011; Li et al. 2011). Ning et al. (2011) speculate however that as China’s society develops, changes in lifestyle will lead to more participation in high-risk sports that could lead to an increase in the number of sport-related SCIs.
Spinal cord injuries due to diving are commonly reported around the world, and their proportion is highest in Australia (9.4%) (Ring et al. 1986), Brazil (9.3%) (da Paz et al. 1992), and Finland (9.2%) (Dahlberg et al. 2005). Studies from the USA, Canada, and Japan also reported frequencies of SCI due to diving as high as 8.5% (Acton et al. 1993), 2.4% (McCammon and Ethans 2011) and 1.3% (Shingu et al. 1995), respectively. In a recent study focused on SCIs due to shallow-water diving in South Africa, Vlok et al. (2010), reported increasing numbers of SCIs from 2003 to 2009. The occurrences of injuries were most common during summer holidays, and among young males who consumed alcohol.
In South America, Africa, and Oceania, rugby was reported as a leading sports-related cause of SCI. In 16 studies examining SCI due to rugby, the incidence was as high as 4.6 per 10,000 player hours in South Africa (Jakoet and Noakes 1998), and the prevalence ranged from 1.7 (Rugby League) to 6.8 (Rugby Union) per 100,000 players in Australia between 1995 and 2003 (Berry et al. 2006). Hermanus et al. (2010) reported an increasing frequency of SCIs due to playing rugby in the South African Rugby Union between 1980 and 2007. The highest frequency of SCI was reported to be in 2006. Forwards sustained 76% of all SCIs, club players 60%, and those age 17 years had the highest number of SCIs (Hermanus et al. 2010). Other major causes of sports related SCI include skiing/snowboarding (N=7), ice hockey (N=4) and horseback riding (N=2). A report from the United States identifies skimboarding as a new cause of SCI, especially among young males (Collier et al. 2010). The authors’ note that as the sport increases in popularity and more extreme maneuvers are performed, that associated risk of SCI with the sport will likely increase (Collier et al. 2010).