Injury profile, prevalence and risk factors among South African Para-athletes

Background: Para-athletes are at heightened risk of sports-related injuries due to sport-specific demands, disability types and environmental exposures. Despite global research, limited data exist on injury profiles in low-resource settings such as South Africa. Objectives: To profile injuries, determine their prevalence and identify associated risk factors among South African Para-athletes. Method: A cross-sectional study was conducted among 86 South African Para-athletes (response rate: 74.14%) using a self-developed questionnaire. Data on demographics, disability type, sporting history, injury history and risk factors were analysed using descriptive statistics and logistic regression. Results: Among 86 Para-athletes (median age 27 years), limb deficiency was the most common impairment (50%) and athletics (44%) the leading sport. Athletes trained 5.3 sessions per week and competed 3.4 days/quarter; adapted environments were significantly more common in men (67% vs. 33%, p = 0.015). Median injuries over 12 months were three, mainly in the lower quadrant (74%, p = 0.617), with strains (34%) and sprains (24%) most frequent. Multivariable analysis showed that swimming (odds ratio [OR] = 0.05, p = 0.010) and strength training (OR = 0.05, p = 0.002) were strong protective factors against injury. In contrast, skipping a warm-up during training significantly increased injury risk (OR = 3.2, 95% confidence interval [CI]: 1.3–7.9, p = 0.011), with athletes who did not warm up being more than three times as likely to sustain an injury compared with those who performed a warm-up. Conclusion: South African Para-athletes experience a substantial injury burden, highlighting the need for tailored prevention strategies and improved access to rehabilitation and education. Contribution: This study provides the first comprehensive injury profile of South African Para-athletes, informing inclusive, evidence-based interventions.