In elite Olympic class sailing, the incidence of injury is approximately 0.2 injuries/athlete/year with the lumbar and thoracic spine and knee most commonly injured. Injuries in Paralympic class sailing were found to be at a much higher rate of approximately 100 injuries/1,000 days of sailing in 1999. This is a considerable discrepancy, which was thought to be due to more difficult sailing conditions. The majority of injuries were chronic in nature, predominantly sprains and strains of the upper extremity [5]. This may have been due to the level of disability of the competitors.

Nathanson has reported an online survey of recreationally competitive sailors performed during 2006 looking at the relative frequency, patterns, and mechanisms of sailing-related injuries in dinghies and keelboats [6]. A total of 1,715 injuries were reported from 1,188 respondents. The rates of injury and severe injury were 4.6/1,000 and 0.57/1,000 days of sailing, respectively.

A retrospective review of injuries at the Kiel Regatta from 1984 to 1987 showed that sailing injuries requiring hospital care were three times more common in male competitors and twice as likely from sailing dinghies than keelboats [7]. Another series reporting from a similar event revealed that there was a higher risk of injury for the helmsman than for the fore deckhand but injuries were equally distributed among the sexes [8].

When we compare the anatomical regions where injury was reported, there appears to be a distinction between those injuries reported by elite competitors and recreationally competitive sailors versus beginners.

A review of the 2002 Brazilian Olympic team revealed that the most common painful areas were the lower back (52.9 %) and the knees (25–32 %). In Legg’s series, 57 % of New Zealand Olympic sailors’ injuries were reported in the preceding 3 years, with lower back (45 %), knee (22 %), shoulder (18 %), and arm (15 %) reported [9]. The most common injuries in the Kiel Week regatta were again back (44 %) and knee pain (30 %) [10].

By comparison, when participants of beginner dinghy sailing courses were reviewed, the distribution of injuries was as follows: upper limbs 39.5 %, head 32.4 %, lower extremities 39.5 %, and the neck or the trunk 1.6 % [8]. This distinction may well be due to the reporting of injuries and the exertion involved. Beginner sailors when questioned may well report all minor knocks, scrapes, and aches, whereas experienced sailors may discount these minor injuries and only report only significantly injured areas. Similarly inexperienced sailors may be in the boats sailing but not necessarily applying the same exertion in the process of sailing the boat.

Contusions were the most common injury (55 %), followed by grazes (17 %), cuts or tears (14.3 %), bruises (6.3 %), tender spots or blisters or callus (4.6 %), lacerations (1.7 %), pulled muscles (0.4 %), and fractures (0.4 %) in sailing at the Kiel Regatta [8].

Scholne also reports on the same regatta but a different cohort of patients with a similar pattern of findings. Injuries reported featured as open wounds (31.3 %), hand injuries (31.3 %), head injuries (22.1 %), contusions (19.7 %), and various fractures (15.1 %) [7].

In Nathanson’s survey reporting on 70 severe injuries, 25 % were fractures, and 16 % were torn tendons or cartilage. The most frequent injuries for keelboat sailors were leg contusions (11 %), hand lacerations (8 %), and arm contusions (6 %) showing a predilection for upper limb injuries. Injuries sustained in dinghies were leg contusions (11 %), knee contusions (6 %), and leg lacerations (6 %) [11]. Like all surveys, the accuracy of these findings may be subject to a degree of recall bias, with respondents being more likely to remember severe injuries but forget bruises and contusions.

The causes of injuries can be considered to be either accidental acute trauma or overuse activity. Collision with the boom was the most common accidental injury mechanism (31.1 %), followed by putting the rigging up and down (13 %), capsizing (10.5 %), docking and casting off (9.7 %), the handling of sheets (9.2 %), conditions of the harbor (8.8 %), and slipping while on board (6.8 %). Notably stronger and offshore winds made the sailor more accident prone [8]. Injuries in novice and recreational sailing are predominantly acute in nature with contusions and abrasions typically occurring as a result of collisions with the boom or other equipment during maneuvers. The common mechanisms of injury were trip/fall, being hit by object, and being caught in lines. The common factors contributing to injury are tacking heavy weather and jibing.

By comparison, competitive sailing is a physical sport with large forces suddenly applied to muscle groups in order to make the dinghy go faster.

Actions in sailing are sudden sporadic placing muscles at high risk by performing explosive powerful moves. A lack of warming up, stretching, and cooling down surrounding race also increases risk of injury.

Hiking or sitting over the side of the boat with the feet held beneath foot straps places immense strain on the lower back and the knees [12]. In some classes of sailboats, sailors may spend as much as 94 % of the race in the hiking position [13]. Unaccustomed overarching of the back and weak abdominal muscles will lead to excessive loading of the spine. Inadequate leg strength and poor hiking technique are thought to lead to an imbalance between the medial and lateral quadriceps leading to pain [14]. Inadequate fitness training exacerbates muscular imbalances, changing the forces in opposing muscle groups.

When hiking or using a harness to counterbalance the boat with a trapeze, it may be safest to keep the back straight, depending on the hiking style being performed. Using electromyographic analysis to evaluate static hiking, Hall has suggested that body harnesses include rigid padding, shoulder-through-buttock support, and leg strap supports [15].

Maneuvering around the cramped dinghy (Fig. 10.5) and in particular avoiding the boom can be awkward resulting in rotating, hyperextending, locking, or twisting of joints, leading to meniscal or articular cartilage injury principally of the knee.

The handling of the mainsheet against the wind’s resistance to increase the dinghy’s speed may lead to shoulder and arm injuries particularly sudden eccentric loading.

Neville et al. have reported on injuries sustained during training for and competition during the 2003 America’s Cup [16]. This prospective study reported an overall incidence of 8.8 incidents/1,000 sailing and training hours. It is interesting to note that there was a higher rate of injury associated with training, 8.6 injuries per 1,000 h of training compared to 2.2 injuries/1,000 h of sailing.

Neville has prospectively studied the injuries sustained by one America’s Cup team during the 2003 competition [16]. The exposure time consisted of 74 weeks of sailing and training, and 220 injuries and 119 illnesses were recorded. This allowed the determination of 5.7 injuries per 1,000 training/sailing hours.