Ninja warrior injuries: from epidemiology to management and return to sports

Ninja warrior activities have gained considerable popularity worldwide in recent years. Despite the increasing number of participants, there is limited research on the epidemiology of musculoskeletal injuries in these activities. This study aims to investigate the frequency, types, and severity of injuries sustained during ninja warrior activities, identify common treatment approaches and assess potential risk factors for delayed return to sports.

This was a cross-sectional observational study based on self-reported data collected via an online questionnaire developed by orthopedic surgeons following a thorough review of the literature. The survey, disseminated online, was available from May 2023 to October 2024, and 103 Ninja Warrior athletes participated. The questionnaire assessed demographics, sports participation, injury characteristics, management, and post-injury outcomes, including return-to-sport metrics. T-test was used to compare normally distributed continuous data among two groups, and regression analysis was employed to identify and quantify factors influencing time to return to sport. The significance level was set at P<0.05.

The most commonly injured body parts were the shoulder (19.1%), ankle (12.6%), and wrist (11.5%). The rings/laches obstacle accounted for 30.43% of all reported injuries. Overuse was identified as the leading mechanism of injury, responsible for 30.8% of cases. Tendon ruptures and/or ligament tears (25.8%), sprains (16.9%), and fractures (15.7%) were the most frequently reported injury types. Surgical intervention was required in 10.7% of injuries, including three arthroscopic labrum repairs for shoulder injuries and three anterior cruciate ligament (ACL) reconstructions, among other procedures. RTS was found to be delayed in association with higher BMI (P=0.004), VAS score (P=0.001), and 5 or more training sessions per week (P=0.044).

Ninja warrior training holds significant risk for musculoskeletal injuries, most commonly overuse and upper extremity injury. The rings/laches are particularly prone to injury, suggesting that adequate technical skill assessment prior to execution may be warranted. Additionally, increased BMI, higher VAS at time of injury, and 5 or more training sessions per week were found to be associated with delayed return to sport.