Sports-Related Injury Patterns Among Athletes with Intellectual Disabilities

We present a scoping review regarding sports-related injury patterns in athletes with intellectual disabilities. We examined studies published through February 1, 2025 that were retrieved through librarian performed literature searches. The search resulted 646 articles of which 12 articles were selected. The majority of relevant studies are reports of injuries at individual Special Olympics games and do not address detailed injury specifics. Quality of data improved over time. Little literature exists investigating injury patterns in athletes with intellectual disability; however, there has been an increase in the number and quality of studies starting in 2022. Further research is recommended.

Key points

•
Historically, academic literature for athletes with intellectual disabilities has focused on safety for sports participation, not on injury epidemiology.
•
Although still limited, there has been an increase in the number and quality of research on injury epidemiology in athletes with intellectual disability.
•
More research is needed in the area of injury epidemiology in athletes with intellectual disabilities in order to draw formal conclusions.

Abbreviations

AAIDD	American Association of Intellectual and Developmental Disabilities
IOC	International Olympic Committee
IRB	institutional review board
PRISMA	Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Introduction

Intellectual disability is defined by the American Association of Intellectual and Developmental Disabilities (AAIDD) as a disability with onset any time before the age of 22 that significantly impacts intellectual functioning and adaptive behavior. Intellectual functioning is an individual’s mental capacity, often tested by intelligence quotient testing. Adaptive behavior is characterized by functional skills relevant to daily life, including conceptual skills (i.e. language, math skills), social skills (i.e. interpersonal skills, social problem solving), and practical skills (i.e. personal hygiene care, money management).

The population of athletes with disabilities can represent athletes with intellectual disabilities participating in a general sport setting/group/organization-or- in a sports setting/group/organization specifically for individuals with disabilities, specifically for individuals with intellectual disabilities, integrated for individuals with and without disabilities, or integrated for individuals with and without intellectual disabilities.

Perhaps the most well-known sports organization for individuals with intellectual disabilities is the Special Olympics. Special Olympics provides global novice through elite Olympic-style sports for athletes with intellectual disabilities, ages 8 and older. ^,^,^,

Athletes with intellectual disabilities represent a unique athlete population. Academic literature surrounding this population generally addresses sports participation or pre-participation screening. ^,^, There has been a particular focus on screening for atlantoaxial instability in Down syndrome and the possible risk of secondary cervical spinal cord injury. ^,^, The authors have noticed there has been less emphasis on epidemiologic information regarding sports-related injuries in this population.

The purpose of this article was to comprehensively review and critically appraise the available literature regarding injury patterns in athletes with intellectual disabilities.

Methods

Data Sources and Search

The scoping review occurred through an initial search in 2021 and then later through a search in 2025 to add articles between 2021 and 2025. In the 2021 search, studies published through April 1, 2021, were retrieved through PubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, a systematic search was initiated by a clinical librarian utilizing both keyword and controlled vocabulary combinations of the following terms: sports injury, athletic injury, sports trauma, intellectual disability, intellectual disability disorder, learning disability, learning disorder, mental retardation, and mental deficiency. No studies were excluded based on publication date, language, or study type.

Using the same search methods as utilized in 2021, in 2025 a literature search occurred retrieving studies published April 2, 2021 through February 1, 2025 through PubMed, Embase, Web of Science, and CINAHL studies. Following PRISMA protocols, a systematic search was initiated by a clinical librarian utilizing both keyword and controlled vocabulary combinations of the following terms: sports injury, athletic injury, sports trauma, intellectual disability, intellectual disability disorder, learning disability, learning disorder, mental retardation, and mental deficiency. No studies were excluded based on publication date, language, or study type.

Study selection

Inclusion Criteria

Using Rayyan, a web-based application built for systematic reviews, 2 authors (MD, PC in 2021; MD, PP in 2025) reviewed the search results independently and included studies based on the following criteria. All conflicts were settled to gain consensus at each step of the study selection process (title, abstract, and paper). All clinical research study designs were included, as well as cross-over and case-control studies. Included studies were studies of which full text was available in English and of which epidemiologic information regarding sports-related injuries was reported in individuals with intellectual disabilities. The AAIDD’s definition of intellectual disability was followed.

Exclusion Criteria

Published abstracts (i.e. from academic conferences) without accompanying full text articles were excluded. Qualitative studies, which did not include quantitative epidemiologic data regarding sports-related injuries, were excluded. Animal and observational studies were excluded, as were case reports and case series.

Studies involving individuals with various disabilities, without data separated for individuals with intellectual disabilities, were excluded. Studies with an emphasis on the pediatric/adolescent population were excluded. As this article was focused on sports-related injuries in organized sports, studies that reported injuries related to physical education or non-organized physical activity was excluded. Studies were excluded if injury data were reported aggregately among athletes and non-athletes (i.e. coaches, fans; etc) with injury data not able to be specifically isolated for athletes. Likewise, studies were excluded if sports-related medical incidents were recorded in a way in which medical illness and sports-related injury data were not at all able to be separated. Studies in which sports-related injuries were not a primary outcome were also excluded.

Data Extraction

The lead author (MD) performed basic data extractions of all included studies, focusing on information highlighted by the International Olympic Committee (IOC) Injury and Illness Epidemiology Consensus Group as important components to include in sports medicine injury epidemiology research and following a similar structure to the work by Weiler and colleagues. ^, A standardized appraisal process utilized a 10-point scale created for and used specifically by prior sports injury outcomes systematic reviews. This scale was created to assess key points important for assessing the quality and validity of sports-injury related clinical research studies. The 10-point scale, based on the work of Van Gent and colleagues, Hoy and colleagues, Bahr, and Lopes and colleagues with wording by Weiler and colleagues is shown in Box 1 . ^,^,^,^, Each reviewer (MD, PC in 2021; MD, PP in 2025) independently scored the included articles using this scale. All conflicts in scoring were resolved to reach consensus.

Box 1

The 10-point scale to assess quality of sports-related injury research, based on the work of Van Gent and colleagues, Hoy and colleagues, Bahr, and Lopes and colleagues with specific question wording by Weiler and colleagues ^,^,^,^,

1.
Definition of injury described in each study (yes/no).
2.
Studies with prospective designs that presented incidence or prevalence data (yes/no).
3.
Description of the population of athletes (eg, sport, disability, classification) or the player positions (eg, goalkeepers or forward players) that participated in the study (yes/no).
4.
Was the process of inclusion of athletes in the stydy at random (ie, not by convenience) or was data collection performed with the entire target population (yes/no).
5.
Data analysis was performed with at least 80% of the athletes included in the study (‘yes’ or “no”).
6.
Were data regarding the injuries reported by a healthcare professional (yes/no).
7.
Was the same mode of data collection (e-mail, telephone, interview, etc.) used (yes/no).
8.
Was the diagnosis conducted by medical doctors (yes/no).
9.
Was there a follow-up period of at least 6 mo for prospective studies (assessed by ‘yes’ or ‘no’).
10.
Were the incidence or prevalence rates of injury expressed by a ratio that represents both the number of injuries, as well as the exposure to sport (e.g. IR/1000 h of sport exposure, and this criterion was assessed by ‘yes’ or ‘no’).

Results

The literature search yielded 646 search results, of which 12 total articles were included for analysis. ^,^,^,^,^,^,^,^,^,^,^, Fig. 1 includes the full PRISMA diagram. Table 1 presents basic data extraction, performed by lead author (MD), of key information from all included studies. ^,^,^,^,^,^,^,^,^,^,^,^,^,^, Table 2 presents 10-point scale scoring consensus by 2 authors (MD, PC in 2021; MD, PP in 2025).

A flowchart showing the process of selecting studies for a research review. — Fig. 1

Table 1

Basic data extracted by lead author (MD) from 12 included articles ^,^,^,^,^,^,^,^,^,^,^,^,^,

Article	Conflicts of Interest Declared by Authors	Ethics Board/Institutional Review Board Approval	Study Design	Sports Setting	Study Participants	Study Outcome(s)	Length of Athletic Exposure (days)	Definition of Sports-Related Injury	Number, Age, and Sex of Athletes	Disability Characteristics of Study Subjects	Number of Sports-Related Injuries ^,	Sports Injury Patterns Noted	Calculated Injury Incidence per 1000 Athlete Hours	Other Incidence Reports by Athletic Exposure
Lead Author: Birrer Title: The Special Olympics: An Injury Overview Journal: The Physician and Sportsmedicine Year: 1984	Not reported	Not reported	Not reported, but prospective cohort study implied	New Jersey State Special Olympics:July 1980 & July 1981	Special Olympics athletes (track and field, martial arts, badminton, weight lifting, and dancing); non-athletes (data separated)	Medical incidents recorded by health care personnel (injury, illness)	Not reported	Not reported	n: 2056 Age: Not reported Sex: 1191 M, 865 F	Athletes with intellectual disability (referred to as handicapped athletes in the article) , further disability information not described	40 ^,	Lacerations/abrasions: 15 Contusions: 13 Mild strains: 8 Mild sprains: 4	Information not available to calculate	Not reported
Lead Author: McCormick Title: Injury and illness surveillance at local Special Olympics games Journal: British Journal of Sports Medicine Year: 1990	Not reported	Institutional Review Board approved	Not reported, but prospective cohort study implied	Special Olympics Spring Games: Galveston, Texas (19 teams); Additional second local competition (24 teams)	Special Olympics athletes (track and field, gymnastics, equestrian, soccer, swimming, diving)	Medical incidents recorded by health care personnel (injury, illness)	3	“An injury resulting directly from participation in a sports event”.	n: 541 Age: Not reported Sex: Not reported	Athletes with intellectual disability. Athletes with Down syndrome (162), without Down syndrome (615)	4	Track and field: Leg muscle strains: 2; Patellar subluxation: 1 Diving: Hand injury: 1	Calculated by 2 methods (Based on author’s calculations and adjusted for 1000 athlete hours): Method 1 (using event time): 0.4 injuries per 1000 athlete hours Method 2 (using measured activity time): 70 injuries per 1000 athlete h	Calculated by 2 methods: Method 1 (using event time): 0.0004 injuries per participant hour Method 2 (using measured activity time): 0.07 injuries per participant hour
Lead Author: Robson Title: The Special Olympics Games for the mentally handicapped- United Kingdom 1989 Journal: British Journal of Sports Medicine Year: 1990	Not reported	Not reported	Not reported, but prospective cohort study implied	Special Olympics Games in Leicester, UK 8/19/1989–8/26/1989: 18 UK regional teams; French and German teams	Special Olympics athletes (track and field, cycling, equestrian, swimming, lawn bowling, soccer, gymnastics, basketball, netball, and table tennis); non-athletes (data separated)	Medical incidents recorded by health care personnel (injury, illness)	8	Not reported	n: 1512 Age: Not reported Sex: 942 M, 570 F	Athletes with intellectual disability. Athletes with Down syndrome (417), Cerebral Palsy, and other conditions as listed in article	Not able to be calculated	Knee/back/orthopedic: 42 Ankle/foot: 29 Bruising/muscle strains: 15 Others as in article	Information not available to calculate	Not reported
Lead Author: Perlman Title: Special Olympics athletes and the incidence of sports-related injuries Journal: Journal of the Massachusetts Dental Society Year: 1994	Not reported	Not reported	Not reported, but retrospective chart review implied	Special Olympics World Games data 1989 (Nevada), 1990 (Scotland), 1991 (Minnesota), 1993 (Austria) (although the World Games Data do not appear to be presented in the Injury Section of the Report) Special Olympics Chapter data July 1992-October 1993: Florida/Miami, Idaho, Kansas, Kentucky, Louisiana, Massachusetts, Michigan, Nebraska, New York, North Carolina, Tennessee, West Virginia	Special olympics athletes (basketball, track and field, softball, alpine skiing, soccer, bowling, rollerskating, aquatics, cross country skiing, volleyball, others in article);volleyball, others in article); non-athletes (data separated	Medical incidents as recorded by insurance claims	Not reported	Not reported	n: 389,000- it is implied that this number is the number for the combined data from Chapter and World Games but not directly stated. Age/Sex: Chapter: 22.2% 12 and under, 40.8% 13–20, 27.1% 21–39, 10.0% 40 and over, 62.1% male World: 4.2% 12 and under, 46.7% 13–20, 45.0% 21–39, 4.1% 40 and over, 68.1% male	Athletes with intellectual disability. Athletes with Down syndrome (World Games: 14.3%; Chapters: 14h.1%)	Not able to be calculated	Chapter data: Basketball: 25 sprains, 16 fractures, 13 bruises, 1 concussion; Softball: 15 sprains, 10 fractures, 7 bruises, 1 concussion; track and field: 9 sprains, 6 fractures, 9 bruises, 1 concussion, soccer: 3 sprains, 5 fractures, 1 bruise, 0 concussions, alpine skiing 4 sprains, 1 fracture, 2 bruises, 0 concussions; others reported in article.	Information not available to calculate	Not reported
Lead Author: Batts Title: The Medical Demands of the Special Athlete Journal: Clinical Journal of Sports Medicine Year: 1998	Not reported	Not reported	Prospective Cohort Study	Special Olympics Hawaii Summer Games: 1993, 1994, 1995, 1996	Special Olympics athletes (aquatics, tee ball, softball, softball throw, powerlifting, shot put, wheelchair and developmental athletics, standing long jump, running long jump, high jump, track and relay, victory dance)	Medical incidents recorded by health care personnel (injury, illness)	12	Not reported	n: 2326 Age: 8–76 Sex: Not reported	Athletes with intellectual disability , further disability information not described	52	16 abrasions, 14 strains (muscle or tendon), 8 sprains (joint or ligament), 7 contusions, 4 lacerations, 2 blisters, 1 nail avulsion	Information not available to calculate	Not reported
Lead Author: Galena Title: Connecticutt State Special Olympics: Observations and Recommendations Journal: Connecticut Medicine Year: 1998	Not reported	Not reported	Retrospective Chart Review	Special Olympics Connecticut State Summer Games: 1994, 1995, 1996	Special Olympics athletes (summer sports; specifics not reported)	Medical incidents recorded by health care personnel (injury, illness)	Not reported	Not reported	n: Unclear from reporting Age: Age range 8–76; Mean ages from pooled samples of 100 athletes: 30.1 in 1994, 31.3 in 1995, 30.8 in 1996 Sex: numbers not indicated but reported as fairly equivalent	Athletes with intellectual disability, Down syndrome (13 of a pooled sample of 100), Traumatic brain injury (6 of a pooled sample of 100), Cerebral palsy (1 out of a pooled sample of 100)	375 traumatic injuries though details of only 153 are described	Head and neck: 19 Upper extremity: 29 Chest: 7 Lower extremity: 103	Information not available to calculate	Not reported
Lead Author: Wheeler Title: A report of the medical team activity at the 2009 Special Olympics GB Journal: British Journal of Sports Medicine Year: 2012	None	Not reported	Prospective Cohort Study	Special Olympics Summer Games Great Britain 2009	Special Olympics athletes (athletics, cycling, equestrian, judo, kayaking, football, swimming, sailing, basketball, badminton, bowling, boccia, ten-pin bowling, gymnastics, golf, Kwik cricket, netball, powerlifting, table tennis, tennis, and Motor Activities Training Program); nonathletes (data separated)	Medical incidents recorded by health care personnel (event medical team records, Red Cross team records, St. John’s Ambulance crew records)	7	Not reported	n: 2414 Age: Only reported for those having medical consultation- mean age 28.2 (range 6–78) Sex: Only reported for those having medical consultation- 63% male	Athletes with intellectual disability (referred to as learning disability in the article) , further disability information not described	Not able to be calculated	Musculoskeletal injuries: 56.7% of medical consultations for athletes Head injuries: 1.6% of medical consultations for athletes	Information not available to calculate	Study reported number of medical consultations by athlete hours, but this reflects illnesses and injuries, not sports-related injuries alone.
Lead Author: Galdieri Title: Descriptive epidemiology of orthopedic injury and illness during the Special Olympics of Pennsylvania Summer Games from 2008 to 2017 Journal: Orthopedic Reviews Year: 2022	Not reporte	Institional Review Board approved	Retrospective chart review	Special Olympics Pennsylvania Summer Games 2008–2017	Special Olympics athletes (aquatics, athletics, basketball, bowling, equestrian, golf, gymnastics, softball, tennis, no sport listed)	Medical incidents (categorized as illnesses, injuries, or first aid) as recorded in logs from medical staff members at Special Olympics Pennsylvania Summer Games 2008–2017	30	Games, most often musculoskeletal and included dental injury, lacerations, or an eye injury. An orthopedic injury often required the athlete to stop, limit, or modify participation following the incident. ^,	Sex: Only reported for those having medical consultation- 58.2% male	Special Olympics athletes, further disability information not described	453 (455 minus 2 infections reported in the injury section of the paper and removed from injury category by our author team)	Pains, Sprains, Strains (lower leg sprain most common)- 202, Contusions (thigh contusion most common) 142, Lacerations 31, Fractures/Avulsion 19, Concussions 14, Ligament/Tendon 14, Unspecified 10, Other 9, Dislocations/Subluxations 5, Neurologic 5, Swelling 2	Information not available to calculate	Information not available to calculate
Lead Author: Kons Title: Injuries in Judo Athletes With Disabilities: Prevalence, Magnitude, and Sport-Related Mechanisms. Journal: Journal of Sport Rehabilitation Year: 2022	Not reported	Human Research Ethics Committee Approved	Cross-sectional study	Brazilian Judo athletes with various disabilities were recruited to complete a questionnaire regarding previous sports-related injuries	Brazilian Judo athletes with various disabilities	Self-reported historic sports-related injuries	N/A	Not reported	n: 51 Age: mean 34.6 (standard deviation 11.7) Sex: 70.6% male	Physical disability 17, intellectual disability 10 (10 with Down Syndrome, 1 with autism), visual condition 24		100% of athletes (including 100% of athletes with intellectual disability) reported an injury in the prior 2 y. Further details regarding sports-related injury specifics in Brazilian Judo athletes with intellectual disability was not reported.	Information not available to calculate	Information not available to calculate
Lead Author: Newman Title: Injury Trends in Special Olympics Athletes From the 2018 USA Games Journal: Clinical Journal of Sport Medicine Year: 2022	None	Deemed Exempt by Institutional Review Board	Retrospective chart review	Special Olympics United States of America (USA) Games 2018 in Seattle, Washington (Summer sports)	Special Olympics athletes (athletics, basketball, bocce, bowling, flag football, golf, gymnastics, powerlifting, soccer, softball, stand-up paddleboard, swimming, tennis, volleyball)	Medical incidents (categorized as MSK, non-MSK, or minor) as recorded in mobile application from medical staff members at Special Olympics USA Games 2018	6	Overall definition of sports-related injury not defined. Categories of injuries defined: “MSK (MSK: sprain, strain, and bony injury), non-MSK (neurologic, dermatologic, psychological, abdominal, cardiorespiratory, allergic, dental, and other extertional-related issues), and minor (including ice, bandaging, and massage)”.	n: 2,251 Age: not reported Sex: not reported	Special Olympics athletes, further disability information not described	744	Musculoskeletal injuries were the most common types of injuries for gymnastics, tennis, powerlifting, softball, volleyball, and basketball. Non-musculoskeletal injuries were the most common injuries for standup paddleboarding, athletics, bocce, swimming, bowling, and golf Minor injuries were the most common injuries for soccer and flag football	Information not available to calculate	Individual sports = injuries/1000 exposures: Gymnastics (routine) = 48.1, Tennis (match) = 43.2, Standup paddleboard (race) = 142.9, Athletics (race, throw, jump) = 53.7, Powerlifting (lift) = 24.9, Bocce (match) = 20.6, Swimming (race) = 34.7, Bowling (match) = 17.6, Golf (9 holes) = 31.5 Team Sports: Injuries per Game: Softball = 1.9, Soccer = 1.7, Flag football = 1.6, Volleyball = 0.8, Basketball = 0.8
Lead Author: Garcia-Carrillo Title: Prevalence of sports injuries in Para Athletics throwers-a retrospective cohort study Journal: Advances in Rehabilitation Year: 2024	None	Ethics Board approved	Cross-sectional study	Para Athlete Throwers 18+ with at least 1 y of training in Para athletics were recruited to complete a questionnaire regarding previous sports-related injuries in the past 12 mo	Para athlete throwers 18+	Self-reported historic sports-related injuries	365	“Any condition that reduces an athlete’s normal state of full health, irrespective of its consequences for the athlete’s sports participation or performance or whether the athlete sought medical attention” ^,	n: 4 athletes reporting the intellectual impairment sports class Age: Only reported for all athletes together and not for athletes reporting the intellectual impairment sports class (overall mean 31) (overall range 18–55) Sex: Only reported for all athletes together and not for athletes reporting the intellectual impairment sports class (overall 70% male)	4 Para athlete throwers reporting a sports class of intellectual impairment. Further disability characteristics of this group were not provided.	3 of the 4 athletes with intellectual impairment reported an injury in the prior 12 mo	Injury patterns for athletes with intellectual impairment were not specified. Injury patterns were presented for the overall group of Para athletes only and not further presented by disability type.	Information not available to calculate	Information not available to calculate
Lead Author: Morales Title: Injury Risk Analysis among Judo Athletes with Intellectual Disabilities Age: mean 20.79 (± 3.44) Journal: International Journal of Sports Medicine Year: 2024	None	Institional Review Board approved	Cross-sectional study	Judo athletes with intellectual disability were recruited to complete a questionnaire regarding sports-related injuries in the past year	Judo athletes with intellectual disability	Self-reported historic sports-related injury		“Any new musculoskeletal pain or injury that has caused changes in normal training or competition in terms of mode, duration, intensity or frequency, whether or not training or competition time has been missed.” ^,	n: 182 Age: mean 20.79 (± 3.44) Sex: 64.8% male	Level 1: 6.0% Level 2: 20.9% Level 3: 27.5% Level 4: 31.9% Level 5: 13.7%	20	Injuries by anatomic site: Feet/toes (35%) Knees (15%) Shoulders (15%) Lower legs (10%) Head/face (10%) Elbow/arm (5%) Back (5%) Hand (5%)	Injury incidence calculated per 1000 athlete hours overall and by sex, age, weight class, and sport divisioning and was presented in a figure. Based on the figure, overall injury incidence was between 1.0 and 1.1 injuries/1000 athlete hours.	Injury burden was also calculated by dividing the number of missed days from injury by the number of hours of judo and multiplying by 1000 and was presented in a figure. Based on the figure, the injury burden was between 22.5 and 25.0 d missed per 1000 athlete hours.