The health benefits of sport are myriad, but sport also carries an inherent risk of injury. This systematic review summarizes musculoskeletal injury epidemiology in elite and recreational para-athletes, and highlights research gaps.

Five electronic databases were searched for relevant articles: Ovid Medline, Ovid Medline In Process & Other Non-Indexed Citations, Ovid Embase, Cumulative Index to Nursing and Allied Health (CINAHL), and Web of Science. Evaluation and data extraction were performed by two independent examiners. Inclusion criteria were: (a) written in English; (b) published in a peer-reviewed journal between January 1975 and June 2017; (c) describe para-athletes participating in recreational or elite sport; and (d) describe sports-related, acute traumatic or chronic overuse musculoskeletal injury.

Fifty full-text manuscripts were reviewed. Seated para-athletes sustain upper extremity injuries more commonly, while ambulant para-athletes frequently sustain lower extremity injuries. The upper extremity, including shoulder, elbow, wrist/hand, is the most commonly injured anatomical area in all para-athletes, unlike able-bodied athletes for whom lower extremity injuries predominate. Increased age and spinal cord injury may increase risk of upper extremity injury. Sprains, strains, blisters and lacerations are the most common injuries among paralympians, but winter paralympic sports carry higher risk of head injury, fracture and contusion, possibly due to the high-velocity elements. Male and female summer paralympic athletes have similar overall injury rates, and football 5-a-side, para-powerlifting, goalball, wheelchair fencing, and wheelchair rugby are consistently highest-risk sports. Para-ice hockey, alpine skiing, and snowboarding are highest-risk winter sports. Upper and lower extremity injury rates match in winter sport, unlike summer sport trends. Injury data for recreational and youth para-athletes are sparse.

MSK injury epidemiology data continues to mature. Recreational and youth athletes remain under studied. Updating such data may accelerate the development of injury prevention strategies and lifetime injury models for para-athletes.