Incidence and Management of Severe Muscle and Tendon Injuries in Elite Korean Badminton Players: A Focus on Gender-Specific Patterns
Article information
Abstract
PURPOSE
Although muscle and tendon injuries are common among badminton players, there has been little research into these specific injuries. This study aimed to investigate the incidence and management practices of severe muscle and tendon injuries in a sample of elite Korean badminton players, focusing on sex differences.
METHODS
This study included 126 athletes aged 19–23 years with an average age of 21.1±1.4 years, providing 135 injury data points (65 male and 70 female). Participants were asked to describe their experiences with muscle and tendon injuries that limited training participation for more than one month during their athletic careers, as well as their post-injury management practices, through structured interviews.
RESULTS
Approximately 54% of the participants sustained at least one severe muscle or tendon injury during their athletic careers, with a reinjury rate of 56.2%. Most injuries occurred during training sessions, had a chronic onset, and were more common in the dominant limbs. Common injuries included patellar tendinopathy, Achilles tendinopathy/rupture, and calf muscle tears. Male athletes were more likely to sustain injuries from smash or stroke movements (odds ratio, OR=3.80, 95% confidence interval, CI=1.14–12.65, p=.030) than female athletes, and had a slightly higher likelihood of sustaining upper limb injuries (OR=3.55, 95% CI=0.96–13.13, p=.058). Psychological concerns following an injury were primarily related to the risk of reinjury; however, more than half of the athletes resumed training without specialized rehabilitation or medical authorization.
CONCLUSIONS
The study findings indicate that elite badminton players are highly susceptible to severe muscle and tendon injuries, with a significant risk of reinjury, and exhibit gender-specific patterns, emphasizing the importance of gender-specific management strategies, comprehensive rehabilitation, and medical authorization to ensure a safe return to training.
INTRODUCTION
Badminton is one of the world's most popular racquet sports, with an estimated 200 million participants [1,2]. It is also a popular recreational sport in South Korea, with approximately 4,200 clubs and over 1.5 million players [3]. Since its inclusion as an Olympic sport in 1992, the number of elite badminton players in Korea has steadily increased, with 2,450 students and professionals registered as elite athletes by 2025 (https://g1.sports.or.kr/member/login.do).
While the playing styles may differ, the fundamental skills and footwork are similar between singles and doubles of badminton [4-6]. Key offensive skills include the clear, a high, long shot aimed at the oppo-nent's backcourt; the smash, an aggressive overhead shot with a down-ward trajectory; the drop shot, dropping the shuttle close to the net; and the hairpin, a precise shot of dropping the shuttle directly in front of the net [4]. Lunge-based footwork, rapid directional changes, and jumps and landings are the three most common footwork techniques used by players when performing and defending against these skills. Throughout the game, players move quickly in multiple directions and perform movements requiring high joint mobility for reach and reaction [5]. These biomechanical demands place players at high risk of injury.
In badminton, non-contact and overuse injuries are more common than contact injuries [2,5,7-9]. For example, several studies on badminton injuries found that strains and sprains were the most common types of injury [2,8-11]. A prospective study of 20 elite international badminton players found that muscle and tendon injuries accounted for 51.4% of all injuries, making them the most common [7]. Achilles tendon pain and dysfunction, as well as knee extensor and tendon injuries, are also common issues for players [2,12,13]. Frequent overhead strokes increase the risk of rotator cuff injuries in the shoulder [5,7,14]. The prevalence of overuse injuries indicates a high risk of recurrence throughout an athlete's career [12], as well as the possibility that players will train and compete despite pain [5].
Previous research found that injuries resulting in absences of more than 28 days accounted for 17% of all cases [7], even though the majority of badminton injuries were minor [7,15]. Severe injuries that require extended time away can have a significant impact on players' performance and careers, necessitating systematic and careful management. To the best of our knowledge, there are few studies that focus specifically on severe muscle and tendon injuries sustained during badminton training and competition. Notably, while previous research has suggested that injury patterns may differ between male and female players due to strategic, anatomical, and structural differences [16,17], studies on injuries with a gender-specific focus are also uncommon. As a result, the purpose of this study was to examine the patterns of severe muscle and tendon injuries sustained during training and competition by elite Korean badminton players, as well as to explore post-injury management practices, with a particular emphasis on gender differences.
METHODS
1. Data Collection and Injury Interviews
This study collected data from elite male and female badminton players who participated in nationwide badminton tournaments. The data collection period lasted approximately six months, from March 1 to September 30, 2024. To investigate severe muscle and tendon injuries sustained during athletic careers, a structured questionnaire was employed, and two PhD-level researchers conducted face-to-face interviews. The researchers were thoroughly trained beforehand following a standardized protocol to ensure consistency in both the questions and their delivery, as well as to minimize interviewer bias. To reduce bias in injury experience related to career duration and age, the study targeted only university and professional players aged 19 to 23. Participation was en-tirely voluntary and anonymous.
The interview consisted of three sections. The first section collected demographic characteristics, including age, height, weight, athletic career, dominant hand, and primary competition type. The second section focused on experiences of muscle and/or tendon injuries restricting participation in team training and matches for more than three weeks during badminton activities. Details of timing of the first injury, side of the body affected (dominant or non-dominant), type of event (training or competition), pattern of onset of injury (acute or chronic), location and diagnosis of injuries, motion at time of injury (lunge, jump/landing, push-off/step, smash/stroke), reinjury, and return to play (RTP) time were assessed in this section. The final section assessed post-injury management, including whether specialized rehabilitation was undertaken, medical authorization prior to RTP, surgical intervention, and psychological concerns (reinjury, performance decline, ranking drop, and return pressure) following injury.
2. Study Participants
Table 1 summarizes the characteristics of the study participants. A total of 126 adult male and female badminton players participated in this study, nine of whom reported multiple injuries. Each injury was recorded as a separate data point, resulting in a total of 135 data points (65 men and 70 women) included in the analysis. The participants had an average age of 21.1±1.4 years, and their average athletic career was 13.3±1.9 years. The male athletes had an average height of 177.7±4.9 cm and a weight of 76.2±7.0 kg, while the female athletes averaged 167.4±4.6 cm in height and 61.8±4.7 kg in weight. All participants were officially registered with the Korea Badminton Association and affiliated with domestic universities or professional teams. Prior to participation, the purpose and procedures of the study were explained to each athlete, and informed consent was obtained.
General characteristics of participants (Mean±SD)
3. Definitions
Severe injuries were defined as those that end a season or career, involve a time loss of more than 30 days, or require surgical intervention [18]. Participants were instructed to report only injuries diagnosed by a physician through imaging techniques such as ultrasound or MRI. RTP was defined as the point when the athlete was able to participate fully in technical team training. A reinjury was characterized by the recurrence of a previous injury in the same body part multiple times. In such cases, participants were instructed to record only the episode with the longest RTP period.
4. Data Analysis
Continuous variables were presented as means and standard deviations, while categorical variables were presented as frequencies and percentages. An independent t-test was used to compare differences in age, height, weight, and athletic career duration by gender. Chi-squared or Fisher's exact tests were used to compare variables related to severe injury characteristics and post-injury management between groups. RTP times were converted to categorical variables for analysis due to non-normal distribution and right skewness. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for muscle and tendon injury features and post-injury management by gender. The significance level for hypothesis testing was set at α<0.05. All statistical analyses were performed using IBM SPSS version 25.0 (IBM Corp., Armonk, NY, USA).
RESULTS
As shown in Table 1, female athletes were slightly more likely to experience severe muscle and tendon injuries than male athletes (χ²=3.166, p =.075), but this difference was not statistically significant. Of all participants, 30 male athletes (46.2%) and 43 female athletes (61.4%) had experienced at least one severe muscle or tendon injury during their professional athletic career.
Table 2 presents the descriptive statistics of athletes who sustained severe muscle and tendon injuries. Most injuries occurred during the collegiate/professional period (54.8%), followed by the high school period (35.6%). Injuries were generally more common during training (75.3%) than during competition (24.7%). Injuries predominantly had a chronic onset (64.4%) and occurred on the dominant side of the body (72.6%). The lower limbs were the most commonly affected body parts (79.5%), followed by the upper limbs (16.4%) and the trunk (4.1%). Jumping/landing (28.8%) and lunge (27.4%) were the primary movements leading to injury, followed by push-off/step (23.3%) and smash/stroke (20.5%). Notably, there was a statistically significant difference in the movements leading to injury between genders (χ2 =9.464, p =.024).
Comparison of severe muscle and tendon injury statistics in badminton players by gender
Fig. 1 illustrates the specific diagnoses of severe muscle and tendon injuries, clearly highlighting the anatomical locations and types of injuries. Patellar tendinopathy, Achilles tendinopathy/rupture, and rotator cuff tear were frequent tendon injuries, while calf muscle tear and hamstring muscle tear were common muscle injuries. There were no gender differences in these specific diagnoses.
Types of severe muscle and tendon injuries in badminton players by gender.
Table 3 shows post-injury management practices, psychological concerns, and RTP duration by gender. Of the 73 athletes who sustained fractures, only 49.3% received specialized rehabilitation, and 34.2% returned to training with medical authorization. Although injuries requiring surgery were minimal at 4.1%, reinjury rates were relatively high at 56.2%. The primary post-injury psychological concern for athletes was worry about reinjury (52.1%), closely followed by performance decline (45.2%). Although not statistically significant, there was a slight difference in RTP duration categories by gender (χ2 =5.478, p =.065)
Comparison of post-injury management, psychological concerns, and RTP time for severe muscle and tendon injuries in badminton players by gender
Fig. 2 shows the ORs and 95% CIs for the prevalence of severe muscle and tendon injuries by gender. It also shows the ORs and 95% CIs for injuries during smash/stroke movement, in the upper limbs. Using male athletes as a reference (OR=1), female athletes showed a slightly higher likelihood of sustaining severe muscle and tendon injuries (OR=1.86, 95% CI=0.94-3.69, p =.076), but this difference was not statistically significant. Male athletes had a higher incidence of smash/stroke injuries (OR=3.80, 95% CI=1.14-12.65, p =.030) and were somewhat more likely to sustain upper limb injuries (OR=3.55, 95% CI=0.96-13.13, p =.058) than female athletes (OR=1).
Prevalence of severe muscle and tendon injuries, smash/stroke-related injuries, and upper limb injuries according to gender. The values in parentheses represent the 95% confidence intervals.
DISCUSSION
This study examined severe muscle and tendon injuries among elite adult badminton players. As a result, we found that approximately 54% of participants had sustained at least one severe injury during their careers, with a significant number suffering reinjury. Injuries occurred primarily during training, were often chronic, and were most prevalent in the dominant limb. Injury patterns as well as the specific injury-causing movements varied by gender, with female players being more likely to sustain upper-limb injuries than male players.
The current study findings showed that muscle and tendon injuries occurred more often during high-level competition, which is consistent with injury epidemiology studies conducted in other racquet sports [19]. For example, Fu et al. [19] showed that the injury incidence of tennis increased with competition level (from low to high), most likely due to increasing training intensity and competition frequency. Nonetheless, the lack of a comprehensive injury surveillance system in badminton makes it difficult to compare muscle and tendon injury rates at different levels from middle/high school to college/professional players. Comprehensive epidemiological studies at all levels of competition are required to reduce the risk of injury and effectively prevent injuries among elite badminton players [20].
Concerning gender differences in injury mechanisms, this study found that female athletes exhibited a somewhat higher prevalence of severe muscle and tendon injuries compared to male athletes, which was consistent with previous research [15]. According to a longitudinal study conducted by Miyake et al. [15], female Japanese national badminton players were more likely to be injured during training than male counterparts. Zhang et al. [17] showed that female athletes had more leg stiffness than males when landing on one foot after a backhand overhead shot, increasing their risk of non-contact injuries like ACL tears. In contrast, Shariff et al. [2] found no significant gender differences in musculoskeletal injury patterns among Malaysian badminton players. Such gender disparities between studies could be attributed to differences in injury data collection environments (training vs. competition), the severity of injuries reported, and others. More research is needed to understand gender-specific injury patterns better, using consistent injury definitions, severity, and data collection methods.
It was particularly interesting to note that the affected body regions of muscle and tendon injuries, injury-causing movements, and the severity of injuries may differ depending on gender. The study found that male athletes were slightly more likely to sustain upper extremity injuries, such as rotator cuff tears, and had a significantly higher risk of injuries caused by smash/stroke movements than female athletes. This gender difference in injury mechanisms could be attributed to gender-specific playing styles. In support of this notion, Kim and Sung [21] reported that male players use high-intensity jump smashes more frequently than female players, who primarily rely on low-intensity attacking routines such as rallies and drop shots. Furthermore, male players make more shots per set than female players, exposing them to a higher risk of upper limb injuries [14]. Taken together, the findings of the current and previous studies suggest that injury prevention strategies should be tailored to gender-specific characteristics, with male athletes focusing on upper body strength enhancement and the refinement of smash/stroke techniques, and female athletes prioritizing strength and flexibility training to improve joint stability and reduce injury risks.
Consistent with previous studies examining overall badminton injuries [8,9], this study found that muscle and tendon injuries usually occur during training, have a chronic onset, and are more likely to affect the dominant side of the body. Because racquet sports require players to use their dominant arms and legs frequently, injuries to the dominant limb are unavoidable [8,15]. Furthermore, overuse injuries are more common during training than matches due to the longer duration [5,9]. The findings of previous and current studies highlight the need for an injury management strategy in badminton that considers load regulation during training and reduces stress on dominant limbs.
Our findings on the primary injury types and injury-inducing movements in badminton players are consistent with previous studies [5,7,8]. This study found that the most common injury types were patellar tendinopathy, Achilles tendinopathy/rupture, and calf muscle tears, primarily caused by lunge and jump/landing movements. Intense lunge movements and repetitive jumping have been shown to place significant stress on the patellar and Achilles tendons of the dominant leg, increasing the risk of overuse injuries such as patellar and Achilles tendinopathy [5,8,12]. In contrast, this study found that upper extremity injuries were mainly caused by smash motions, which is similar to previous research reporting that smash motions contribute significantly to upper extremity injuries [7]. The findings from previous and current studies suggest that monitoring high-impact repetitive movements and adjusting training intensity as needed are important strategies for preventing muscle and tendon injuries in badminton players.
Consistent with previous study findings [22], this study found that even with a few injuries requiring surgical intervention reported, the reinjury rate was relatively high at 56.2%. Despite the high reinjury rate, many athletes resumed training without undergoing rehabilitation or obtaining medical clearance. Muscle and tendon injuries may appear minor, but they can cause ongoing symptoms throughout an athlete's career [22]. Ironically, the athletes in our study identified reinjury and performance decline as their primary psychological concerns following injury. The findings from current and previous studies suggest that a structured process of professional rehabilitation and a thorough medical examination before returning to training will be necessary to avoid reinjury and support long-term athletic performance.
This study is clinically relevant because it investigates severe muscle and tendon injuries that can cause long-term absences in badminton players, providing foundational information for developing gender-specific injury prevention and management programs. At the same time, we acknowledge the limitations of this study. First, the non-probabilistic sampling method may not adequately represent the entire population, increasing the risk of selection bias. As a result, there are limitations to generalizing the study findings. Second, data collection using a retro-spective design may have compromised the accuracy of injury prevalence and RTP periods due to recall bias. Third, while singles and doubles badminton events have distinct physical demands and tactics [23,24], this study did not conduct an event-specific analysis. To better understand muscle and tendon injuries in badminton, a prospective design with additional event types should be used in future research.
CONCLUSION
In this study, we found that elite Korean badminton players sustained severe muscle and tendon injuries with insufficient post-injury care. Female athletes had a slightly higher injury rate than male athletes, whereas males were more prone to upper limb injuries caused by smashes or strokes. These findings emphasize the importance of gender-specific injury management strategies, as well as a structured approach to rehabilitation and medical authorization, to ensure athletes can return to training safely.
Notes
ACKNOWLEDGMENTS
We would like to thank Sungkyunkwan University for editing and administrative support.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
AUTHOR CONTRIBUTIONS
Conceptualization: M Song, S Yoo, K Kim; Data curation: S Yoo, K Kim, C Chen; Formal analysis: S Yoo, K Kim, C Chen; Funding acquisition: M Song; Methodology: S Yoo, K Kim, C Chen; Project administration: S Yoo; Writing - original draft: M Song, S Yoo, C Chen; Writing - review & editing: M Song, S Yoo.